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

Abstract

Background: There is no established insulin regimen in T2DM patients receiving parenteral nutrition. Aims: To compare the effectiveness (metabolic control) and safety of two insulin regimens in patients with diabetes receiving TPN.

Management of Glucose Control in Noncritically Ill, Hospitalized Patients Receiving Parenteral and/or Enteral Nutrition: A Systematic Review

“…Four of the clinical trials were considered of medium quality, indicating a low risk of bias in all domains except for performance and detection bias, which was deemed reasonable with a near impossibility of blinding [31,32,33,34]. The other studies were deemed to be of limited quality, with high risk of bias in the domains of lack of primary outcome definition and selective or incomplete reporting (Supplementary Figure S1).…”

“…Mean glucose levels during total PN did not significantly differ between groups (9.2 ± 2.0 vs. 9.6 ± 2.4 mM, p = ns); however, mean glucose two days after cessation of total PN was higher in the group that had received 100% of their exogenous insulin requirements added to the PN feeding bag (8.9 ± 2.5 vs. 7.9 ± 2.4 mM, p = 0.024). The authors did not provide any details on the requirement for insulin therapy after cessation of nutrition support [32]. Another randomized controlled clinical trial of PN patients contrasted two different basal insulin regimens.…”

Fish Oil Enriched Intravenous Lipid Emulsions Reduce Triglyceride Levels in Non-Critically Ill Patients with TPN and Type 2 Diabetes. A Post-Hoc Analysis of the INSUPAR Study

“…The results were extracted from the INSUPAR trial [14] (complete details available in the main article). The study included >18 years non-critically ill type 2 diabetes in-hospital patients who started with TPN (considering that it provides more than 70% of the estimated total energy expenditure) for any cause and that would predictably continue with TPN for at least five days.…”

“…In the INSUPAR trial, previously published by our group, we assessed two insulin regimens in adult inpatients with type 2 diabetes in a non-critical setting with indication for total parenteral nutrition (TPN; subcutaneously administered glargine insulin vs. regular insulin inside the TPN bag) [14]. Of the 161 patients assessed, 80 (49.7%) received TPN with fish oil enriched emulsions and 81 other ILEs.…”

Measurement of insulin in multilayer bags for parenteral nutrition

“…Ambos regímenes han demostrado tener una eficacia similar. Sin embargo, la adición de insulina regular a las bolsas de NP se ha relacionado con una menor tasa de hipoglucemias (3)(4)(5), mientras que el empleo de la insulina glargina consigue un mejor control metabólico tras la interrupción de la NP (5).…”