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STATE-OF-THE-ART PAPER

Insulin as an Anti-Inflammatory and Antiatherogenic Modulator

Paresh Dandona, MD, PhD^_*,_*, Ajay Chaudhuri, MD^_*, Husam Ghanim, PhD^_* and Priya Mohanty, MD

^_* Kaleida Health, Buffalo, New York
Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, Buffalo, New York

Manuscript received April 7, 2008; revised manuscript received October 3, 2008, accepted October 7, 2008.

^_* Reprint requests and correspondence: Dr. Paresh Dandona, Diabetes-Endocrinology Center of WNY, 3 Gates Circle, Buffalo, New York 14209 (Email: pdandona{at}kaleidahealth.org).

Data demonstrate the anti-inflammatory effects of insulin and proinflammatory effects of glucose. These data provide a mechanistic justification for the benefits of maintaining euglycemia with insulin infusions in hospitalized patients. Regimens that infuse fixed doses of insulin with high rates of glucose are usually associated with hyperglycemia, which may neutralize the beneficial effects of insulin. Therefore, we propose that such regimens should be avoided and instead replaced by insulin infusions that normalize and maintain blood glucose at a reasonably low level and ensure that plasma insulin is maintained at levels high enough to provide clinically relevant anti-inflammatory and cardioprotective effects. Trials to test this hypothesis are in progress.

Key Words: hyperglycemia • acute coronary syndromes • diabetes mellitus • insulin

Abbreviations and Acronyms   ACS = acute coronary syndromes   AMI = acute myocardial infarction   CABG = coronary artery bypass graft   CRP = C-reactive protein   GIK = glucose, insulin, potassium   ICU = intensive care unit   NF-kB = nuclear factor-kappa B   NO = nitric oxide   SAA = serum amyloid A   TLR = toll-like receptor

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