38. Third-party reimbursement for diabetes care, self-management education, and supplies. Diabetes Care 2003;26(Suppl. 1):S143–144
39. Eiland L, Goldner W, Drincic A, Desouza C. Inpatient hypoglycemia: a challenge that must be addressed. Curr Diabetes Rep 2014;14:445
40. Frisch A, Chandra P, Smiley D, Peng L, Rizzo M, Gatcliffe C, Hudson M, Mendoza J, Johnson R, Lin E, Umpierrez GE. Prevalence and clinical outcome of hyperglycemia in the perioperative period in noncardiac surgery. Diabetes Care 2010;33:1783–1788
41. Umpierrez GE, Smiley D, Jacobs S, Peng L, Temponi A, Mulligan P, Umpierrez D, Newton C, Olson D, Rizzo M. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes undergoing general surgery (RABBIT 2 surgery). Diabetes Care 2011;34:256–261
42. Halkos ME, Puskas JD, Lattouf OM, Kilgo P, Kerendi F, Song HK, Guyton RA, Thourani VH. Elevated preoperative hemoglobin A1c level is predictive of adverse events after coronary artery bypass surgery. J Thoracic Cardio Surg 2008;136:631–640
43. Furnary AP, Wu Y, Bookin SO. Effect of hyperglycemia and continuous intravenous insulin infusions on outcomes of cardiac surgical procedures: the Portland Diabetic Project. Endocr Pract 2004;10(Suppl. 2):21–33
44. Golden SH, Peart-Vigilance C, Kao WH, Brancati FL. Perioperative glycemic control and the risk of infectious complications in a cohort of adults with diabetes. Diabetes Care 1999;22:1408–1414
45. Lazar HL, Chipkin SR, Fitzgerald CA, Bao Y, Cabral H, Apstein CS. Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. Circulation 2004;109:1497–1502
46. Lipshutz AKM, Gropper MA. Perioperative glycemic control: an evidence-based review. Anesthesiology 2009;110:408–421
47. Gandhi GY, Nuttall GA, Abel MD, Mullany CJ, Schaff HV, O’Brien PC, Johnson MG, Williams AR, Cutshall SM, Mundy LM, Rizza RA, McMahon MM. Intensive intraoperative insulin therapy versus conventional glucose management during cardiac surgery: a randomized trial. Ann Intern Med 2007;146:233–243
48. Ljungqvist O. Insulin resistance and outcomes in surgery. J Clin Endocr Metab 2010;95:4217–4219
49. Brown L, Heuberger R. Nothing by mouth at midnight: saving or starving? A literature review. Gastroenterol Nurs 2014;37:14–23
50. Crenshaw JT. Preoperative fasting: will the evidence ever be put into practice? Am J Nurs 2011;111:38–43
51. Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N, McNaught CE, MacFie J, Liberman AS, Soop M, Hill A, Kennedy RH, Lobo DN, Fearon K, Ljungqvist O. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. Clin Nurt 2012;31:783–800
52. Wang ZG, Wang Q, Wang WJ, Qin HL. Randomized clinical trial to compare the effects of preoperative oral carbohydrate versus placebo on insulin resistance after colorectal surgery. Br J Surg 2010;97:317–327
53. Rosmarin DK, Wardlaw GM, Mirtallo J. Hyperglycemia associated with high, continuous infusion rates of total parenteral nutrition dextrose. Nutrit Clin Pract 1996;11:151–156
54. Korytkowski MT, Salata RJ, Koerbel GL, Selzer F, Karslioglu E, Idriss AM, Lee KKW, Moser AJ, Toledo FGS. Insulin therapy and glycemic control in hospitalized patients with diabetes during enteral nutrition therapy: a randomized controlled clinical trial. Diabetes Care 2009;32:594–596
55. Noblett SE, Watson DS, Huong H, Davison B, Hainsworth PJ, Horgan AF. Pre-operative oral carbohydrate loading in colorectal surgery: a randomized controlled trial. Colorectal Disease 2006;8:563–569
56. Svanfeldt M, Thorell A, Hausel J, Soop M, Rooyackers O, Nygren J, Ljungqvist O. Randomized clinical trial of the effect of preoperative oral carbohydrate treatment on postoperative whole-body protein and glucose kinetics. Br J Surg 2007;94:1342–1350
57. Cohen LS, Sedhom L, Salifu M, Friedman EA. Inpatient diabetes management: examining morning practice in an acute care setting. Diabetes Educ 2007;33:483–492
58. Donihi AC, Abriola C, Hall R, Korytkowski MT. Getting the timing right in the hospital: Synching insulin administration with meal tray arrival. Diabetes 2010;59:1028–P
59. Jovanovic L, Giammattei J, Acquistapace M, Bornstein K, Sommermann E, Pettitt DJ. Efficacy comparison between preprandial and postprandial insulin aspart administration with dose adjustment for unpredictable meal size. Clin Therap 2004;26:1492–1497
60. Ratner R, Wynne A, Nakhle S, Brusco O, Vlajnic A, Rendell M. Influence of preprandial vs. postprandial insulin glulisine on weight and glycaemic control in patients initiating basal-bolus regimen for type 2 diabetes: a multicenter, randomized, parallel, open-label study (NCT00135096). Diabetes Obes Metab 2011;13:1142–1148
Chapter 6
Glycemic Control in the Setting of Parenteral Nutrition or Enteral Nutrition via Tube Feeding
Cecilia C. Low Wang, MD,1 R. Matthew Hawkins, PA-C, MMSc,2 Roma Gianchandani, MD,3 and Kathleen Dungan, MD4
1Associate Professor of Medicine/Director, Glucose Management Team University of Colorado School of Medicine/University of Colorado Hospital Aurora, CO. 2Physician Assistant/Instructor, Department of Endocrinology, Diabetes, and Metabolism, University of Colorado School of Medicine Anschutz Medial Campus, Aurora CO. 3Associate Professor, Department of Internal medicine/Metabolism, Endocrinology and Diabetes Director, Hospital Hyperglycemia Program University of Michigan Medical Center, Ann Arbor, MI. 4Ohio State University, Wexner Medical Center, Columbus, OH.
DOI: 10.2337/9781580406086.06
Introduction
Parenteral nutrition (PN) and enteral nutrition (EN) via tube feeding (TF) are used both within and outside the hospital setting to provide nutrition in individuals who are not able to eat via the traditional oral route because of various factors, including recovery from major abdominal surgery, critical illness, malabsorption, dysphagia, decreased level of consciousness, oropharyngeal processes, and esophageal dysmotility. The incidence of hyperglycemia with or without diagnosed diabetes in patients receiving EN via TF is unclear, but it may range from 34 to 50%.1 For hospitalized patients receiving PN, the prevalence of hyperglycemia ranges from 28 to 44% when a glucose threshold of 200 mg/dL is used,2,3 and up to 90% with a lower glucose threshold of 150 mg/dL.3,4 In another study, 51% of patients on PN were found to have at least one blood glucose (BG) measurement >140 mg/dL.5
The development of hyperglycemia during EN via TF/PN increases the risk of complications and mortality. Adverse consequences may include cardiac complications, infections, sepsis, acute kidney injury, and increased mortality. Pasquel et al. found an increased risk of pneumonia (odds ratio [OR] 3.1, 95% confidence interval [CI] 1.4–7.1), acute renal failure (OR 2.3, 95% CI 1.1–5.0), and mortality (OR 2.8, 95% CI 1.2–6.8, P = 0.02) for patients on total parenteral nutrition (TPN) with a BG >180 mg/dL within 24 h of starting PN.4 A multicenter study in Spain reported a 5.6-fold risk of mortality after adjusting for multiple factors in patients with a mean BG >180 mg/dL during PN infusion as compared with a mean
