Abstract
The occurrence of hypoglycemia in patients receiving parenteral nutrition (PN) is
low, yet its consequences can be detrimental. Treatment of hyperglycemia with insulin
to achieve optimal blood glucose control is challenging and potentially associated
with increased risk of the development of hypoglycemia. The objective of this study
was to determine the association of patient characteristics on the risk of hypoglycemia
among patients receiving concomitant PN and insulin therapy. This retrospective cohort
study was conducted from January 1, 2008, to December 31, 2011, and included 1,657
patients who received PN. There was a significant decrease in the occurrence of hypoglycemia
observed over time: 9.1% (43 of 475) in 2008, 6.4% (30 of 468) in 2009, 5.8% (20 of
347) in 2010, and 3.5% (13 of 367) in 2011 (P=0.013). Patients in whom hypoglycemia developed had a significantly longer duration
on PN (18.0 vs 8.1 days, P<0.0001) as well as more days requiring insulin in the PN (16.1 vs 2.7 days, P<0.0001). The strongest predictors of hypoglycemia were: receiving PN in the ICU (OR
1.86, 95% CI 1.16 to 3.01), history of diabetes (OR 2.10, 95% CI 1.26 to 3.51), days
on PN (OR 0.93, 95% CI 0.91 to 0.95), and an insulin drip (OR 3.14, 95% CI 1.81 to
5.42). With the identification of patient factors that contribute to an increase in
hypoglycemia, existing protocols can be modified to treat hyperglycemia and prevent
hypoglycemia.
Keywords
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Biography
K. F. Kinnare is a nutrition support dietitian, Walgreens Infusion Services, Wood Dale, IL; at the time of the study, she was a clinical dietitian at Rush University Medical Center, Chicago, IL.
Biography
C. A. Bacon is a clinical dietitian, Rush University Medical Center, Chicago, IL.
Biography
Y. Chen is a clinical dietitian, Rush University Medical Center, Chicago, IL.
Biography
S. J. Peterson is a clinical dietitian, Rush University Medical Center, Chicago, IL.
Biography
D. C. Sowa is clinical nutrition manager/internship director, Rush University Medical Center, Chicago, IL.
Article info
Publication history
Published online: January 23, 2013
Accepted:
October 11,
2012
Footnotes
FUNDING/SUPPORT No financial or material support was utilized for this research project
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
Identification
Copyright
© 2013 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.
