Insulin Therapy and Glycemic Control in Hospitalized Patients With Diabetes During Enteral Nutrition Therapy

Korytkowski, Mary T.; Salata, Rose J.; Koerbel, Glory; Selzer, Faith; Karslioglu, Esra; Idriss, Almoatazbellah M.; Lee, Kenneth K.W.; Moser, A. James; Toledo, Frederico G.S.

doi:10.2337/dc08-1436

Cited by 131 publications

(116 citation statements)

References 17 publications

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“…Enteral NS Group: eight studies [19,20,21,28,29,30,31,32] evaluated different insulin regimens for glycemic control in patients receiving enteral support (Table 1a). Two RCTs and 6 cohort studies comprising 1,203 patients were reviewed.…”

Section: Resultsmentioning

confidence: 99%

Insulin Regimens to Treat Hyperglycemia in Hospitalized Patients on Nutritional Support: Systematic Review and Meta-Analyses

Viana

Viana²,

Tavares³

et al. 2017

Ann Nutr Metab

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Background: The best insulin regimen to treat hyperglycemia in hospitalized patients on nutritional support (NS) is unclear. Methods: We searched electronic databases to identify cohort studies or randomized clinical trials in order to evaluate the efficacy of different insulin regimens used to treat hyperglycemia in hospitalized patients on NS on diverse outcomes: mean blood glucose (MBG), hypoglycemia, length of stay in hospital, and mortality. Results: Seventeen studies from a total of 5,030 were included. Enteral Group included 8 studies; 1,203 patients using rapid, glargine, NPH, or Premix insulin; MBG 108-225 mg/dL; hypoglycemia 0-13%. In indirect meta-analyses, NPH insulin ranked best for glucose control (MD 95% CI -2.50 mg/dL [2.65 to -2.35]). Parenteral Group included 4 studies; 228 patients using regular and glargine or NPH insulin; MBG 137-202 mg/dL; hypoglycemia 0-40%. In meta-analyses comparing regular insulin added to parenteral nutrition bag with glargine, MBG (MD 95% CI -3.78 mg/dL [-11.93 to 4.37]; I² = 0%) or hypoglycemia frequency (RR 95% CI 1.37 [0.43-4.32]; I² = 70.7%) did not differ. The description related to hospital length of stay and mortality was inconsistent between groups. Conclusions: The best insulin regimen to treat hyperglycemia in hospitalized patients on NS has not been established; best results using insulin regimens with NPH in enteral nutrition do not seem to be clinically relevant.

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Section: Resultsmentioning

confidence: 99%

Insulin Regimens to Treat Hyperglycemia in Hospitalized Patients on Nutritional Support: Systematic Review and Meta-Analyses

Viana

Viana²,

Tavares³

et al. 2017

Ann Nutr Metab

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“…Mean daily blood glucose, as well as daily peak value, were similar in the SSRI and glargine groups, without any significant difference both in glycemic control and in the frequency of hypoglycemia. The authors concluded that more prospective randomized studies were needed in order to investigate strategies for better glycemic control and identify specific glycemic targets in diabetic inpatients receiving nutrition support (19). Park and cols.…”

Section: Discussionmentioning

confidence: 99%

Specific use of CSII during enteral nocturnal nutrition in a child with type 1 diabetes, Hashimoto's thyroiditis, and Down syndrome

Piccini

Toni

Barni

et al. 2013

Arq Bras Endocrinol Metab

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SUMMARYThe management of insulin therapy in diabetic patients who have comorbidities that involve nutritional aspects, is a major challenge for diabetes care teams. In diabetic patients with compromised nutritional status, artificial nutrition, both enteral or parenteral, may help in the treatment of chronic and acute diseases, leading to better and faster recover of the health status but, if not adequately associated with insulin therapy, it may negatively affect blood glucose levels and lead to poorer metabolic control. In particular, evidence-based recommendations for the treatment of diabetic patients during enteral nutrition therapy are not currently available and, therefore, medical practices are often based on case reports, rather than outcomes of research. We report our experience with a diabetic patient receiving nocturnal enteral feeding due to comorbidities and malnutrition, who was followed up at our centre and precociously treated with continuous subcutaneous insulin infusion after the onset of type 1 diabetes. There is great need for adequately powered randomized controlled trials to provide scientific evidence for the insulin treatment of diabetic patients undergoing enteral feeding. Arq Bras Endocrinol Metab. 2013;57(5):388-92 SUMÁRIO O manejo da terapia com insulina em pacientes diabéticos que têm comorbidades que envolvam aspectos nutricionais é um grande desafio para os especialistas em diabetes. Em pacientes diabéticos com estado nutricional comprometido, a nutrição artificial, tanto enteral quanto parenteral, pode ajudar no tratamento de doenças crônicas e agudas, levando à recuperação melhor e mais rápida do estado de saúde. Entretanto, se não adequadamente associada à terapia com insulina, a nutrição artificial pode afetar negativamente os níveis de glucose e levar a um pior controle glicêmico. Particularmente, não há recomendações baseadas em evidências para o tratamento de pacientes diabéticos durante a terapia nutricional enteral e, portanto, as práticas médicas são geralmente baseadas em relatos de caso, em vez de desfechos de estudos. Relatamos nossa experiência com uma paciente diabética que recebeu nutrição enteral noturna em função de comorbidades e desnutrição, acompanhada no nosso centro e tratada precocemente com infusão subcutânea contínua de insulina depois do estabelecimento do diabetes tipo 1. Existe grande necessidade de estudos randomizados controlados para se obter evidências científicas sobre o tratamento insulínico de pacientes diabéticos que sejam submetidos à nutrição enteral. Arq Bras Endocrinol Metab. 2013;57(5):388-92

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“…L'hyperglycémie est une complication courante chez les patients hospitalisés qui bénéficient d'une NE, entre 34 et 50 % des patients, variant notamment en fonction du type de population étudiée [25][26][27]. En ce qui concerne la NPT, on a rapporté entre 16 et 30 % de sujets préalablement diabétiques chez les individus des unités de soins intensifs randomisés pour participer aux études d'intervention comparant le traitement par insuline conventionnel et intensif [11].…”

Section: Prévalence Du Diabète Et De L'hyperglycémie Chez Des Patientunclassified

“…Il n'existe en réalité qu'une seule étude randomisée qui compare deux stratégies différentes d'administration d'insuline chez des patients hyperglycémiques non agressés -insuline rapide injectée selon un algorithme préétabli en fonction du monitoring glycémique (avec si nécessaire insuline NPH en supplément) comparée à de l'insuline rapide en combinaison avec de l'insuline glargine [27]. Les deux stratégies démontrent globalement une efficacité comparable.…”

Section: Traitement De L'hyperglycémie Chez Les Patients Non Agressésunclassified

Comment gérer la nutrition artificielle chez un patient diabétique ?

Paquot¹,

DeFlines²,

Preiser³

2014

Nutrition Clinique et Métabolisme

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ARTICLE IN PRESS AbstractHyperglycaemia in patients receiving enteral or parenteral nutrition is a major problem due to its high prevalence and possible consequences in terms of morbidity and mortality. However, the management of diabetes/stress hyperglycaemia during artificial nutrition remains largely unknown, especially in non-critically ill patients. The indications and access routes for artificial nutrition are not different in patients with diabetes/stress diabetes than in non-diabetics. We do not recommend using enteral formulas designed for patients with diabetes. The glycaemic objective must be individualized. We recommend a preprandial blood glucose levels between 100 and 140 mg/dL (5.5 and 7.8 mmol/L) and postprandial levels between 140 and 180 mg/dL (7.8 and 10 mmol/L). A frequent monitoring of capillary glycaemias is mandatory. The best drug treatment for treating hyperglycaemia/diabetes is insulin and we recommend to adapt the theoretical insulin action to the nutrition infusion regimen. The management of these patients needs the help of a multidisciplinary experimented staff.

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Insulin Therapy and Glycemic Control in Hospitalized Patients With Diabetes During Enteral Nutrition Therapy

Cited by 131 publications

References 17 publications

Insulin Regimens to Treat Hyperglycemia in Hospitalized Patients on Nutritional Support: Systematic Review and Meta-Analyses

Insulin Regimens to Treat Hyperglycemia in Hospitalized Patients on Nutritional Support: Systematic Review and Meta-Analyses

Specific use of CSII during enteral nocturnal nutrition in a child with type 1 diabetes, Hashimoto's thyroiditis, and Down syndrome

Comment gérer la nutrition artificielle chez un patient diabétique ?

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