Rosiglitazone may assist with glycemic control in the ICU

Introduction: Hyperglycemia is a frequent sequela of critical illness. Rosiglitazone is an oral hypoglycemic agent of the thiazolinedione class. Thiazolinediones are known to activate peroxisome proliferator-activated receptor γ(PPAR-γ) that decreases inflammation in humans and decreases shock induced by zymosan in mice. Hypothesis: Rosiglitazone can assist with hyperglycemic control in the intensive care unit (ICU). Methods: A hospital billing query identified patients prescribed rosiglitazone while in a major university ICU. Patients who received rosiglitazone as an outpatient prior to hospitalization were excluded. Glycemic control was determined by average daily blood glucose, 24-hour insulin dose, and number of patients requiring an insulin drip. Glycemic control was evaluated on days 0, 3, and 7. Student t test was used to compare means. Fisher exact testing was used to compare insulin regimen before and after starting rosiglitazone. Results: 34 patients were identified. The average Acute Physiology and Chronic Health Evaluation (APACHE) II score was 17.2 ± 4.4. Sixty-five percent were male, 62% were preexisting diabetics. The mean daily blood glucose was 159 ± 30 mg/dL on day 0, 146 ± 37 mg/dL on day 3, and 140 ± 33 mg/dL on day 7 (P <.03 vs day 0). The mean 24-hour insulin dose was 80.6 ± 87.9 U on day 0, 72.2 ± 73.4 U on day 3, and 46.3 ± 57.2 U on day 7 (P <.003 vs day 0). There was 1 major hypoglycemic event. Conclusion: Rosiglitazone may assist glycemic control in the ICU. Despite recent concerns of cardiac safety, further research should be done to evaluate its potential as a short-term therapeutic agent in the ICU, given its anti-inflammatory and antishock profile.