Hyperglycemia during Home Parenteral Nutrition Administration in Patients Without Diabetes

Jithinraj Edakkanambeth Varayil, Siddhant Yadav, John M. Miles, Akiko Okano, Darlene G. Kelly, Ryan T Hurt, Manpreet S. Mundi

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Parenteral nutrition (PN) is a life-sustaining therapy in appropriate clinical settings. In the hospital setting, some nondiabetic patients develop hyperglycemia and subsequently require long-term insulin while receiving PN. Whether similar hyperglycemia is seen in the outpatient setting is unclear. Methods: We studied patients enrolled in the Mayo Clinic Home Parenteral Nutrition (HPN) program between January 1, 2010, and December 31, 2012. Patients were excluded if they had diabetes mellitus type 2 (DM2), had previously received HPN, had taken corticosteroids, or were at risk for refeeding syndrome. Results: Of 144 enrolled patients, 93 met inclusion criteria with 39 patients requiring the addition of insulin to HPN. The mean age of the insulin-requiring group (IR) was higher than that of the non-insulin-requiring group (NIR) (60.74 ± 13.62 years vs 48.97 ± 17.62 years, P <.001). There were 17 (44%) men in the IR group and 26 (48%) men in the NIR group. Mean blood glucose at baseline before starting the infusion was 131.82 ± 49.55 mg/dL in IR patients and 106.16 ± 59.01 mg/dL in NIR patients (P =.03). In the stepwise multivariate analysis for assessing the risk for developing hyperglycemia, HR for age was 1.020 (1.010-1.031), P <.001. Conclusions: Hyperglycemia is a common finding with the use of PN in both the hospital and ambulatory setting in patients without a previous diagnosis of DM2. Age was the most significant predictor of the requirement of insulin in the present study. When hyperglycemia is managed appropriately with insulin therapy, the long-term complications can be minimized.

Original languageEnglish (US)
Pages (from-to)672-677
Number of pages6
JournalJournal of Parenteral and Enteral Nutrition
Volume41
Issue number4
DOIs
StatePublished - May 1 2017

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Home Parenteral Nutrition
Hyperglycemia
Insulin
Parenteral Nutrition
Type 2 Diabetes Mellitus
Refeeding Syndrome
Blood Glucose
Adrenal Cortex Hormones
Outpatients
Multivariate Analysis

Keywords

  • home parenteral nutrition
  • home parenteral nutrition infusate
  • hyperglycemia
  • insulin requirement

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

Hyperglycemia during Home Parenteral Nutrition Administration in Patients Without Diabetes. / Edakkanambeth Varayil, Jithinraj; Yadav, Siddhant; Miles, John M.; Okano, Akiko; Kelly, Darlene G.; Hurt, Ryan T; Mundi, Manpreet S.

In: Journal of Parenteral and Enteral Nutrition, Vol. 41, No. 4, 01.05.2017, p. 672-677.

Research output: Contribution to journalArticle

Edakkanambeth Varayil, Jithinraj ; Yadav, Siddhant ; Miles, John M. ; Okano, Akiko ; Kelly, Darlene G. ; Hurt, Ryan T ; Mundi, Manpreet S. / Hyperglycemia during Home Parenteral Nutrition Administration in Patients Without Diabetes. In: Journal of Parenteral and Enteral Nutrition. 2017 ; Vol. 41, No. 4. pp. 672-677.
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AB - Background: Parenteral nutrition (PN) is a life-sustaining therapy in appropriate clinical settings. In the hospital setting, some nondiabetic patients develop hyperglycemia and subsequently require long-term insulin while receiving PN. Whether similar hyperglycemia is seen in the outpatient setting is unclear. Methods: We studied patients enrolled in the Mayo Clinic Home Parenteral Nutrition (HPN) program between January 1, 2010, and December 31, 2012. Patients were excluded if they had diabetes mellitus type 2 (DM2), had previously received HPN, had taken corticosteroids, or were at risk for refeeding syndrome. Results: Of 144 enrolled patients, 93 met inclusion criteria with 39 patients requiring the addition of insulin to HPN. The mean age of the insulin-requiring group (IR) was higher than that of the non-insulin-requiring group (NIR) (60.74 ± 13.62 years vs 48.97 ± 17.62 years, P <.001). There were 17 (44%) men in the IR group and 26 (48%) men in the NIR group. Mean blood glucose at baseline before starting the infusion was 131.82 ± 49.55 mg/dL in IR patients and 106.16 ± 59.01 mg/dL in NIR patients (P =.03). In the stepwise multivariate analysis for assessing the risk for developing hyperglycemia, HR for age was 1.020 (1.010-1.031), P <.001. Conclusions: Hyperglycemia is a common finding with the use of PN in both the hospital and ambulatory setting in patients without a previous diagnosis of DM2. Age was the most significant predictor of the requirement of insulin in the present study. When hyperglycemia is managed appropriately with insulin therapy, the long-term complications can be minimized.

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