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. 2018 Jun;9(3):1359-1367.
doi: 10.1007/s13300-018-0433-1. Epub 2018 May 3.

Differences in Glycemic Control in Diabetic and Non-diabetic Patients with Parenteral Nutrition Using a Basal plus Correction Insulin Regimen: An Observational, Retrospective Study

Analía Ramos  1 , Fernanda Rabasa  1 , Lilian Mendoza  1 , Joana Cardenete  2 , Pedro Gill  1 , Alba Morilla  1 , Daniel Cardona  2 , Antonio Pérez  3   4   5
Affiliations

Differences in Glycemic Control in Diabetic and Non-diabetic Patients with Parenteral Nutrition Using a Basal plus Correction Insulin Regimen: An Observational, Retrospective Study

Analía Ramos et al. Diabetes Ther. 2018 Jun.

Abstract

Introduction: Hyperglycemia is a frequent complication of parenteral nutrition (PN) in patients both with and without diabetes mellitis (DM). The aim of this study was to evaluate the quality of glucose control achieved with basal plus-correction insulin in surgical patients with and without a history of DM receiving PN.

Methods: Retrospective evaluation of a protocol applied during the period of January 2013-December 2015. The insulin dose was started at 0.4 and 0.3 IU/kg/day in patients with previous DM and without a history of DM, respectively, and the target blood glucose (BG) was < 180 mg/dl. Mean BG levels, insulin total daily dose (TDD) and hypoglycemic (< 70 mg/dl) events on different days of PN were also evaluated.

Results: Forty-one patients with previous type 2 DM and 39 without DM were evaluated. Glycemic control in both groups was as follows: during the first 48 h (230.4 ± 67 vs. 189.4 ± 38 mg/dl, p = 0.002); at the midpoint (224.6 ± 58 vs. 181.3 ± 27 mg/dl, p = 0.003); 48 h before ending TPN (196.4 ± 43 vs. 169.8 ± 40 mg/dl, p = 0.004). Insulin TDD was 0.5 ± 0.3 U/kg/day in patients with DM and 0.37 ± 0.3 units/kg/day in those without DM (p < 0.05). A total of 18 patients experienced hypoglycemic events, without differences between the groups.

Conclusion: A basal-correction insulin regimen is an alternative method for managing hyperglycemia in non-critically ill surgical patients on PN.

Keywords: Diabetic patients; Hyperglycemia; Non-diabetic patients; Parenteral nutrition.

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Figures

Fig. 1
Fig. 1
Glycemic control in all patients, diabetic and non-diabetic patients in relation to the time of PN. *Difference between diabetic and non-diabetic patients. *p < 0.05
Fig. 2
Fig. 2
Proportion of patients with BG < 180 mg/dl in the three study periods
See this image and copyright information in PMC

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