Persistence of Insulin Resistance Following Major Pediatric Burn Injury

Presentation Number: MON 634
Date of Presentation: April 3rd, 2017

Walter J. Meyer III*1, Robert A. Rodriguez1, Sylvia Ojeda1, Joanna Huddleston1 and David N. Herndon2
1Shriners Hospital for Children, Galveston, 2University of Texas Medical Branch, Galveston, TX

Abstract

Introduction: Following major burn injury some children develop an abnormal oral glucose tolerance test (OGTT) characterized by elevated glucose and /or elevated insulin concentrations. The purpose of this study is to determine the time course of these OGTT abnormalities.

Methods: A retrospective review of OGTT’s in pediatric burn survivors [TBSA= 49.6% ± 21.8%] was analyzed post burn injury at: 0-90, 90-270, 270-450, 450-640,640-821 and 821-1711 days. The abnormalities observed were either a fasting plasma glucose ≥100 mg/dl, a glucose at 30, 60 or 90 minutes ≥180 mg/dl, a glucose at 120 min ≥140 mg/dl or normal fasting insulin ≥20 uIU/ml, or at other time points insulin’s ≥70 uIU/ml. Six percent of the children did not receive insulin measurements due to their low body weight. OGTT’s were repeated in a following time period if there was an abnormality noted in the first 90 days. Initially those who were normal were still normal when retested or were assumed to be normal if not retested.

Results:There were 292 children (66% males, Hispanics 90% TBSA was 49.6%±21.8%, 0-5yr, n=141 & 6-19yr, n=151) that were tested at baseline (0-90 days). Per each time point the percent of children with elevated glucose concentrations at the time of testing were the following: 36% (0-90), 11% (90-270), 8% (450-670), 2% (670-821) and 1% (821-1711 days). None of those individuals less than 5 years of age had persistent glucose abnormalities past 90 days.

There were 274 patients tested at baseline (0-90 days) for insulin response to glucose ingestion; 190 patients had abnormal insulin response in the OGTT in the first 90 days.

Of those with abnormal insulin responses 84 patients returned and were retested. Essentially all of these [83 (98.8%)] remained with abnormal insulin concentrations during OGTT. All of these were in the 6-19 year age group.

Conclusion: Post major burn injury, children up to 5 years of age at the time of injury are unlikely to have persistent abnormalities of the OGTT past 90 days. Survivors of major burn injury 6-19 years of age at the time injury who have abnormal glucose tolerance test at 90 days are very likely to have persistent insulin resistance. These results suggest that children surviving major burn injury should be followed for persistent abnormal glucose and insulin repsonses to OGTT.

 

Nothing to Disclose: WJM III, RAR, SO, JH, DNH