Prevalence of Diabetes, Prediabetes, and Stress Hyperglycemia: Insulin Therapy and Metabolic Control in Patients on Total Parenteral Nutrition (Prospective Multicenter Study)

Olveira, Gabriel; Tapia, María José; Ocón, Julia; Cabrejas-Gómez, Carmen; Ballesteros-Pomar, María D.; Vidal-Casariego, Alfonso; Arraiza-Irigoyen, Carmen; Olivares, Josefina; Conde-García, María C.; García-Manzanares, Álvaro; Botella-Romero, Francisco; Quílez-Toboso, Rosa P.; Cabrerizo, Lucio; Matía, Pilar; Chicharro, L.; Burgos, R.; Pujante, Pedro; Ferrer, Mercedes; Zugasti, Ana; Petrina, E.; Manjón, Laura; Diéguez, Marta; Carrera, María; Vila-Bundo, Anna; Urgelés, Juan Ramón; Aragón-Valera, Carmen; Sánchez-Vilar, Olga; Bretón, Irene; García-Peris, Pilar; Muñoz-Garach, Araceli; Márquez, Efren; Olmo, Dolores del; Pereira, José; Tous, María C.

doi:10.4158/ep13441.or

Cited by 18 publications

(13 citation statements)

References 28 publications

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“…Our results are clearly better than the ones obtained in patients with hyperglycemia treated only with subcutaneous insulin regimens (basal plus correction insulin regimen, with no insulin added to PN bag) [17,20]. Despite this, one third of the patients showed a percentage of measurements above 180 mg/dL, results similar to those found by our group previously in people with diabetes [7].…”

Section: Discussionsupporting

confidence: 73%

“…To calculate sample size, we used previous data [7] about noncritically ill diabetic patients who achieved mean blood capillary glucose during PN infusion of 179 ± 46 mg/dL. To detect differences in mean metabolic control during PN infusion of 25 mg/dL between both groups (two tails) with a confidence interval of 95% and a power of 80%, a sample of at least 104 patients is required (52 per group).…”

Section: Sample Sizementioning

confidence: 99%

“…Values above 180 mg/dL are associated with a greater incidence of complications and death in hospitalized patients who receive parenteral nutrition [4,6]. Difficulty to reach an adequate metabolic control is higher in patients with diabetes mellitus who require parenteral nutrition when compared with patients with prediabetes or stress-induced hyperglycemia, despite receiving higher doses of insulin [7].…”

Section: Introductionmentioning

confidence: 99%

“…The most prevailing regimen to control hyperglycemia is the introduction of regular insulin added to TPN bags and using subcutaneous Regular insulin as a correction [7,10,12]. This regimen has the advantage that it can deliver the insulin intravenously at a steady rate alongside carbohydrates, reducing the risk of hypoglycemia, and, in malnourished patients with lack of subcutaneous tissue, it may prevent the need for frequent insulin injections.…”

Section: Introductionmentioning

confidence: 99%

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Regular insulin added to total parenteral nutrition vs subcutaneous glargine in non-critically ill diabetic inpatients, a multicenter randomized clinical trial: INSUPAR trial

Olveira

Abuín-Fernández

2021

Clinical Nutrition

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Section: Discussionsupporting

confidence: 73%

Section: Sample Sizementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Regular insulin added to total parenteral nutrition vs subcutaneous glargine in non-critically ill diabetic inpatients, a multicenter randomized clinical trial: INSUPAR trial

Olveira

Abuín-Fernández

2021

Clinical Nutrition

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“…This observation was not surprising, as aging is associated with decreased insulin release and an increased occurrence of insulin resistance 21 . Furthermore, it was determined in a large prospective multicenter study, including hospitalized noncritically ill patients receiving PN, that patients aged >65 years were at an increased risk for hyperglycemia during their course of PN therapy (OR, 3.8; 95% CI, 1.8–8.4; P = .001) 22 . In the current study, more patients in the older group had a diagnosis of diabetes mellitus, further increasing their predisposition to insulin resistance.…”

Section: Discussionmentioning

confidence: 99%

Metabolic Complications Occur More Frequently in Older Patients Receiving Parenteral Nutrition

et al. 2020

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Background The European Society for Clinical Nutrition and Metabolism Guidelines for Parenteral Nutrition in Geriatric Patients state metabolic complications are more frequent in elderly patients. However, literature provides limited information about metabolic complications in older patients receiving parenteral nutrition (PN). Consequently, the purpose of this study was to compare the development of metabolic complications in older vs younger patients receiving PN. Methods Patients receiving PN from May 1, 2014, to February 7, 2017, at Cooper University Hospital were included. Metabolic complications assessed included acid‐base disturbances, hepatic complications, hypercapnia, hyperchloremia, hyperglycemia, hypernatremia, hypertriglyceridemia, hypochloremia, hypoglycemia, hypokalemia, hypophosphatemia, and refeeding syndrome. Results 595 patients were included (older group [≥65 years]: n = 245, median age: 76 years; younger group [<65 years]: n = 350, median age: 53 years]. Certain characteristics were similar between groups (female, 51%; mean body mass index of 28; critically ill, 34%; central PN, 97%; median duration of PN, 7 days; mean energy provision PN, 25.4 kcal/kg/d; mean dextrose infusion rate, 2.31 mg/kg/min). Overall, metabolic complications developed in 58% of patients and occurred more frequently in older vs younger patients (65.7% vs 53.4%; P = .003). Multivariate logistic analysis demonstrated increased odds of metabolic complications in the older group (odds ratio, 1.55; 95% CI, 1.014–2.375). Conclusions Older hospitalized patients are more likely to develop a metabolic complication during their PN course than younger patients. This study heightens awareness that patients of advanced age are subject to metabolic complications; practitioners should anticipate and resolve complications in a timely manner.

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Nutrition and Hyperglycemia Management in the Inpatient Setting (Meals on Demand, Parenteral, or Enteral Nutrition)

2017

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Patients with and without diabetes mellitus commonly develop hyperglycemia while receiving EN or PN support, placing them at increased risk of adverse outcomes, including in-hospital mortality. Very little new evidence is available in the form of randomized controlled trials (RCT) to guide the glycemic management of these patients. Reduction in the dextrose concentration within parenteral nutrition as well as selection of an enteral formula that diminishes the carbohydrate exposure to a patient receiving enteral nutrition are common strategies utilized in practice. No specific insulin regimen has been shown to be superior in the management of patients receiving EN or PN nutrition support. For those receiving oral nutrition, new challenges have been introduced with the most recent practice allowing patients to eat meals on demand, leading to extreme variability in carbohydrate exposure and risk of hypo and hyperglycemia. Synchronization of nutrition delivery with the astute use of intravenous or subcutaneous insulin therapy to match the physiologic action of insulin in patients receiving nutritional support should be implemented to improve glycemic control in hospitalized patients. Further RCTs are needed to evaluate glycemic and other clinical outcomes of patients receiving nutritional support. For patients eating meals on demand, development of hospital guidelines and policies are needed, ensuring optimization and coordination of meal insulin delivery in order to facilitate patient safety.

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Prevalence of Diabetes, Prediabetes, and Stress Hyperglycemia: Insulin Therapy and Metabolic Control in Patients on Total Parenteral Nutrition (Prospective Multicenter Study)

Cited by 18 publications

References 28 publications

Regular insulin added to total parenteral nutrition vs subcutaneous glargine in non-critically ill diabetic inpatients, a multicenter randomized clinical trial: INSUPAR trial

Regular insulin added to total parenteral nutrition vs subcutaneous glargine in non-critically ill diabetic inpatients, a multicenter randomized clinical trial: INSUPAR trial

Metabolic Complications Occur More Frequently in Older Patients Receiving Parenteral Nutrition

Nutrition and Hyperglycemia Management in the Inpatient Setting (Meals on Demand, Parenteral, or Enteral Nutrition)

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