Safety and Efficacy of Insulins in Critically Ill Patients Receiving Continuous Enteral Nutrition
There is a relative lack of consensus regarding the optimal management of hyperglycemia in patients receiving continuous enteral nutrition (EN), with or without a diagnosis of diabetes. This retrospective study examined 475 patients (303 with known diabetes) hospitalized in critical care setting uni...
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| Veröffentlicht in: | Endocrine practice 2024-04, Vol.30 (4), p.367-371 |
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| container_title | Endocrine practice |
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| creator | Ni, Kevin Hawkins, R. Matthew Smyth, Heather L. Seggelke, Stacey A. Gibbs, Joanna Lindsay, Mark C. Kaizer, Laura K. Low Wang, Cecilia C. |
| description | There is a relative lack of consensus regarding the optimal management of hyperglycemia in patients receiving continuous enteral nutrition (EN), with or without a diagnosis of diabetes.
This retrospective study examined 475 patients (303 with known diabetes) hospitalized in critical care setting units in 2019 in a single center who received continuous EN. Rates of hypoglycemia, hyperglycemia, and glucose levels within the target range (70-180 mg/dL) were compared between patients with and without diabetes, and among patients treated with intermediate-acting (IA) biphasic neutral protamine Hagedorn 70/30, long-acting (LA) insulin, or rapid-acting insulin only.
Among those with type 2 diabetes mellitus, IA and LA insulin regimens were associated with a significantly higher proportion of patient-days in the target glucose range and fewer hyperglycemic days. Level 1 ( |
| doi_str_mv | 10.1016/j.eprac.2024.01.009 |
| format | Article |
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This retrospective study examined 475 patients (303 with known diabetes) hospitalized in critical care setting units in 2019 in a single center who received continuous EN. Rates of hypoglycemia, hyperglycemia, and glucose levels within the target range (70-180 mg/dL) were compared between patients with and without diabetes, and among patients treated with intermediate-acting (IA) biphasic neutral protamine Hagedorn 70/30, long-acting (LA) insulin, or rapid-acting insulin only.
Among those with type 2 diabetes mellitus, IA and LA insulin regimens were associated with a significantly higher proportion of patient-days in the target glucose range and fewer hyperglycemic days. Level 1 (<70 mg/dL) and level 2 (<54 mg/dL) hypoglycemia occurred rarely, and there were no significant differences in level 2 hypoglycemia frequency across the different insulin regimens.
Administration of IA and LA insulin can be safe and effective for those receiving insulin doses for EN-related hyperglycemia.</description><identifier>ISSN: 1530-891X</identifier><identifier>EISSN: 1934-2403</identifier><identifier>DOI: 10.1016/j.eprac.2024.01.009</identifier><identifier>PMID: 38307456</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>continuous enteral nutrition ; enteral nutrition–associated hyperglycemia ; intermediate-acting insulin ; neutral protamine Hagedorn (NPH) insulin</subject><ispartof>Endocrine practice, 2024-04, Vol.30 (4), p.367-371</ispartof><rights>2024 AACE</rights><rights>Copyright © 2024 AACE. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c309t-ac15ccc8230e41c4c268db2c55f84a22beb6cc0fa07983008bfb93a7631fe1273</cites><orcidid>0000-0001-8557-5417 ; 0000-0002-9707-3091</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38307456$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ni, Kevin</creatorcontrib><creatorcontrib>Hawkins, R. Matthew</creatorcontrib><creatorcontrib>Smyth, Heather L.</creatorcontrib><creatorcontrib>Seggelke, Stacey A.</creatorcontrib><creatorcontrib>Gibbs, Joanna</creatorcontrib><creatorcontrib>Lindsay, Mark C.</creatorcontrib><creatorcontrib>Kaizer, Laura K.</creatorcontrib><creatorcontrib>Low Wang, Cecilia C.</creatorcontrib><title>Safety and Efficacy of Insulins in Critically Ill Patients Receiving Continuous Enteral Nutrition</title><title>Endocrine practice</title><addtitle>Endocr Pract</addtitle><description>There is a relative lack of consensus regarding the optimal management of hyperglycemia in patients receiving continuous enteral nutrition (EN), with or without a diagnosis of diabetes.
This retrospective study examined 475 patients (303 with known diabetes) hospitalized in critical care setting units in 2019 in a single center who received continuous EN. Rates of hypoglycemia, hyperglycemia, and glucose levels within the target range (70-180 mg/dL) were compared between patients with and without diabetes, and among patients treated with intermediate-acting (IA) biphasic neutral protamine Hagedorn 70/30, long-acting (LA) insulin, or rapid-acting insulin only.
Among those with type 2 diabetes mellitus, IA and LA insulin regimens were associated with a significantly higher proportion of patient-days in the target glucose range and fewer hyperglycemic days. Level 1 (<70 mg/dL) and level 2 (<54 mg/dL) hypoglycemia occurred rarely, and there were no significant differences in level 2 hypoglycemia frequency across the different insulin regimens.
Administration of IA and LA insulin can be safe and effective for those receiving insulin doses for EN-related hyperglycemia.</description><subject>continuous enteral nutrition</subject><subject>enteral nutrition–associated hyperglycemia</subject><subject>intermediate-acting insulin</subject><subject>neutral protamine Hagedorn (NPH) insulin</subject><issn>1530-891X</issn><issn>1934-2403</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNp9kEFv1DAQhSNERUvhFyAhH7kkjO0kGx84oNUWVqpoVUDiZjmTMfLK6yy2U2n_PV62cOQ0I817M2--qnrDoeHA-_e7hg7RYCNAtA3wBkA9q664km0tWpDPS99JqAfFf1xWL1PaAQhQfHhRXcpBwqrt-qvKfDWW8pGZMLGNtQ4NHtls2TakxbuQmAtsHV0uA--PbOs9uzfZUciJPRCSe3ThJ1vPIbuwzEtim5ApGs--LPlkm8Or6sIan-j1U72uvt9svq0_17d3n7brj7c1SlC5Nsg7RByEBGo5tij6YRoFdp0dWiPESGOPCNbASpX0MIx2VNKsesktcbGS19W7895DnH8tlLLeu4TkvQlUgmmhhOJiUL0oUnmWYpxTimT1Ibq9iUfNQZ_Y6p3-w1af2GrgurAtrrdPB5ZxT9M_z1-YRfDhLKDy5qOjqBMWUkiTi4RZT7P774HfFMqMdQ</recordid><startdate>20240401</startdate><enddate>20240401</enddate><creator>Ni, Kevin</creator><creator>Hawkins, R. Matthew</creator><creator>Smyth, Heather L.</creator><creator>Seggelke, Stacey A.</creator><creator>Gibbs, Joanna</creator><creator>Lindsay, Mark C.</creator><creator>Kaizer, Laura K.</creator><creator>Low Wang, Cecilia C.</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-8557-5417</orcidid><orcidid>https://orcid.org/0000-0002-9707-3091</orcidid></search><sort><creationdate>20240401</creationdate><title>Safety and Efficacy of Insulins in Critically Ill Patients Receiving Continuous Enteral Nutrition</title><author>Ni, Kevin ; Hawkins, R. Matthew ; Smyth, Heather L. ; Seggelke, Stacey A. ; Gibbs, Joanna ; Lindsay, Mark C. ; Kaizer, Laura K. ; Low Wang, Cecilia C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c309t-ac15ccc8230e41c4c268db2c55f84a22beb6cc0fa07983008bfb93a7631fe1273</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>continuous enteral nutrition</topic><topic>enteral nutrition–associated hyperglycemia</topic><topic>intermediate-acting insulin</topic><topic>neutral protamine Hagedorn (NPH) insulin</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ni, Kevin</creatorcontrib><creatorcontrib>Hawkins, R. Matthew</creatorcontrib><creatorcontrib>Smyth, Heather L.</creatorcontrib><creatorcontrib>Seggelke, Stacey A.</creatorcontrib><creatorcontrib>Gibbs, Joanna</creatorcontrib><creatorcontrib>Lindsay, Mark C.</creatorcontrib><creatorcontrib>Kaizer, Laura K.</creatorcontrib><creatorcontrib>Low Wang, Cecilia C.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Endocrine practice</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ni, Kevin</au><au>Hawkins, R. Matthew</au><au>Smyth, Heather L.</au><au>Seggelke, Stacey A.</au><au>Gibbs, Joanna</au><au>Lindsay, Mark C.</au><au>Kaizer, Laura K.</au><au>Low Wang, Cecilia C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Safety and Efficacy of Insulins in Critically Ill Patients Receiving Continuous Enteral Nutrition</atitle><jtitle>Endocrine practice</jtitle><addtitle>Endocr Pract</addtitle><date>2024-04-01</date><risdate>2024</risdate><volume>30</volume><issue>4</issue><spage>367</spage><epage>371</epage><pages>367-371</pages><issn>1530-891X</issn><eissn>1934-2403</eissn><abstract>There is a relative lack of consensus regarding the optimal management of hyperglycemia in patients receiving continuous enteral nutrition (EN), with or without a diagnosis of diabetes.
This retrospective study examined 475 patients (303 with known diabetes) hospitalized in critical care setting units in 2019 in a single center who received continuous EN. Rates of hypoglycemia, hyperglycemia, and glucose levels within the target range (70-180 mg/dL) were compared between patients with and without diabetes, and among patients treated with intermediate-acting (IA) biphasic neutral protamine Hagedorn 70/30, long-acting (LA) insulin, or rapid-acting insulin only.
Among those with type 2 diabetes mellitus, IA and LA insulin regimens were associated with a significantly higher proportion of patient-days in the target glucose range and fewer hyperglycemic days. Level 1 (<70 mg/dL) and level 2 (<54 mg/dL) hypoglycemia occurred rarely, and there were no significant differences in level 2 hypoglycemia frequency across the different insulin regimens.
Administration of IA and LA insulin can be safe and effective for those receiving insulin doses for EN-related hyperglycemia.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>38307456</pmid><doi>10.1016/j.eprac.2024.01.009</doi><tpages>5</tpages><orcidid>https://orcid.org/0000-0001-8557-5417</orcidid><orcidid>https://orcid.org/0000-0002-9707-3091</orcidid></addata></record> |
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| identifier | ISSN: 1530-891X |
| ispartof | Endocrine practice, 2024-04, Vol.30 (4), p.367-371 |
| issn | 1530-891X 1934-2403 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2929128962 |
| source | Alma/SFX Local Collection |
| subjects | continuous enteral nutrition enteral nutrition–associated hyperglycemia intermediate-acting insulin neutral protamine Hagedorn (NPH) insulin |
| title | Safety and Efficacy of Insulins in Critically Ill Patients Receiving Continuous Enteral Nutrition |
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