Can functional electrical stimulation-assisted cycle ergometry replace insulin infusion in patients? A nested substudy in a randomized controlled trial with 6 months' follow-up
Abstract
BACKGROUND: Functional electrical stimulation-assisted cycle ergometry (FESCE) can deliver active exercise to critically patients including those who are sedated. Aerobic exercise is known to stimulate skeletal muscle glucose uptake.
We asked whether FESCE can reduce intravenous insulin requirements and improve insulin sensitivity in intensive care patients. METHOD: We performed an a priori planned secondary analysis of data from an outcome-based randomised-controlled trial (NCT02864745) of FESCE-based early mobility programme vs. standard of care in mechanically ventilated patients.
We analysed glucose profile, glucose intake and insulin requirements during ICU stay in all enrolled patients. In a nested subgroup we performed hyperinsulinemic (120 mIU.m(-2) .min(-1) ) euglycemic clamp at days 0, 7 and 180 (n = 30, 23 and 11, respectively).
RESULTS: We randomised 150 patients 1:1 to receive intervention or standard of care. Seventeen (23%) patients in each study arm had a history of diabetes.
During ICU stay patients received 137+-65 and 137+-88 g/day of carbohydrates (p = 0.97), and 31 vs. 35 (p = 0.62) of them required insulin infusion to maintain blood glucose 8.61+-2.82 vs. 8.73+-2.67 mM (p = 0.75, n = 11254). In those treated with insulin, median daily dose was 53 (IQR 25-95) vs. 62 (IQR 26-96) IU in the intervention and control arm, respectively (p = 0.44).
In the subgroup of patients undergoing hyperglycaemic clamps, insulin sensitivities improved similarly and significantly from acute and protracted critical illness towards 6 months post discharge. CONCLUSION: Functional electrical stimulation-assisted cycle ergometry-based early mobility programme does not significantly reduce insulin requirements in critically ill patients on mechanical ventilation.