Effectiveness of Regular Versus Glargine Insulin in Stable Critical Care Patients Receiving Parenteral Nutrition: A Randomized Controlled Trial

Oghazian, Mohammad Bagher; Javadi, Mohammad Reza; Radfar, Mohammad Hadi; Torkamandi, Hassan; Sadeghi, Mostafa; Hayatshahi, Alireza; Gholami, Kheirollah

doi:10.1002/phar.1546

Cited by 21 publications

(40 citation statements)

References 45 publications

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“…The report on outcomes as well as the description or definition of studied variables were not uniform. Mortality was described only in seven studies [19,20,21,22,23,24,25] and hospital length of stay in 6 [20,21,22,24,26,27]. MBG was described in all but one study [28].…”

Section: Resultsmentioning

confidence: 99%

“…Mean age was 60.7 years, BMI 23.5-27.7 kg/m 2 , and 40% of the patients had diabetes. One study was conducted exclusively in an ICU setting [26], 2 studies included exclusively ward patients [22,33], and one study included patients from ICU and ward settings [34]. Glycemic targets and hypoglycemia definitions were heterogeneous in these studies: the maximum glycemic target ranged from 140 to 180 mg/dL and hypoglycemia was defined as glucose less than 80 mg/dL in 2 studies and around 70 mg/dL in 2 others.…”

Section: Resultsmentioning

confidence: 99%

“…RCTs compared subcutaneous insulin glargine with regular insulin added to the parenteral nutrition bag [26,33]. Meta-analyses did not demonstrate differences in MBG (SMD 95% CI -3.78 mg/dL [-11.93 to -4.37]; I 2 = 0%] or frequency of hypoglycemia (RR 95% CI 2.48 [0.61-10.10]; I 2 = 45.6%) between the 2 insulin regimens (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Parenteral NS Group: four studies [22,26,33,34] evaluated different insulin regimens for glycemic control in parenteral support (Table 1b). Two RCTs and 2 cohort studies comprising 228 patients were reviewed.…”

Section: Resultsmentioning

confidence: 99%

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Insulin Regimens to Treat Hyperglycemia in Hospitalized Patients on Nutritional Support: Systematic Review and Meta-Analyses

Viana

Viana²,

Tavares³

et al. 2017

Ann Nutr Metab

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Background: The best insulin regimen to treat hyperglycemia in hospitalized patients on nutritional support (NS) is unclear. Methods: We searched electronic databases to identify cohort studies or randomized clinical trials in order to evaluate the efficacy of different insulin regimens used to treat hyperglycemia in hospitalized patients on NS on diverse outcomes: mean blood glucose (MBG), hypoglycemia, length of stay in hospital, and mortality. Results: Seventeen studies from a total of 5,030 were included. Enteral Group included 8 studies; 1,203 patients using rapid, glargine, NPH, or Premix insulin; MBG 108-225 mg/dL; hypoglycemia 0-13%. In indirect meta-analyses, NPH insulin ranked best for glucose control (MD 95% CI -2.50 mg/dL [2.65 to -2.35]). Parenteral Group included 4 studies; 228 patients using regular and glargine or NPH insulin; MBG 137-202 mg/dL; hypoglycemia 0-40%. In meta-analyses comparing regular insulin added to parenteral nutrition bag with glargine, MBG (MD 95% CI -3.78 mg/dL [-11.93 to 4.37]; I² = 0%) or hypoglycemia frequency (RR 95% CI 1.37 [0.43-4.32]; I² = 70.7%) did not differ. The description related to hospital length of stay and mortality was inconsistent between groups. Conclusions: The best insulin regimen to treat hyperglycemia in hospitalized patients on NS has not been established; best results using insulin regimens with NPH in enteral nutrition do not seem to be clinically relevant.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Insulin Regimens to Treat Hyperglycemia in Hospitalized Patients on Nutritional Support: Systematic Review and Meta-Analyses

Viana

Viana²,

Tavares³

et al. 2017

Ann Nutr Metab

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“…For this, there is not a firm conclusion about the use of this insulin in patients with parenteral nutrition. [41,42] Corticosteroid therapies Hyperglycemia is a frequent complication in patients with corticosteroids. It is prudent monitoring blood glucose at least 48 hours in patients with high dose of them, [2] and it can be stopped in non diabetic patients when the blood glucose control is under 140 mg/dL without treatment and corticosteroids dose is not going to raise.…”

Section: Journal Of Translational Internal Medicine / Oct-dec 2016 / mentioning

confidence: 99%

Management of hospitalized type 2 diabetes mellitus patients

Marín-Peñalver

Martín-Timón

Cañizo-Gómez

2016

Journal of Translational Internal Medicine

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Both hyperglycemia and hypoglycemia in hospitalized patients are associated with adverse outcomes including increased rates of infection, longer hospital length of stay, and even death. Clinical trials in patients with type 2 diabetes mellitus proved that by improving glycemic control, we can reduce all of them. Insulin is the preferred treatment for glycemic control in most cases, but alternative treatment options that can normalize blood glucose levels without hypoglycemia are being sought. Moreover, hospitalized patients are particularly vulnerable to severe, prolonged hypoglycemia since they may be unable to sense or respond to the early warning signs and symptoms of low blood glucose. Finally, nutritional support, corticosteroid therapy, and surgery increase the risk of hyperglycemia that leads to an increased risk of morbidity and mortality. We review the management of type 2 diabetes mellitus patients who are admitted to the general medical wards of the hospital for a procedure of intercurrent illness.

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Glycemic Control in Adult Surgical Patients Receiving Regular Insulin Added to Parenteral Nutrition vs Insulin Glargine: A Retrospective Chart Review

et al. 2019

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Background Hyperglycemia is a frequent complication in patients receiving parenteral nutrition (PN) and has been associated with an increased risk of mortality. Treatment of hyperglycemia requires insulin therapy; however, the optimal dose and route have not been established. This study aimed to compare regular insulin added to PN (RI‐in‐PN) with subcutaneous insulin glargine for the management of hyperglycemia in patients receiving PN. Methods This retrospective study was conducted at a tertiary medical center and reviewed 113 adult, non–critically ill surgical patient admissions receiving PN over a 5‐year period. The primary outcome was achievement of glycemic control. Secondary outcomes were time to glycemic control, hypoglycemic events, hospital length of stay, and 1‐year mortality. Results The RI‐in‐PN group had a significantly higher percentage of patient admissions who achieved glycemic control compared with the insulin glargine group (71.8% vs 48.6%, P = 0.017). There was no difference in time to glycemic control, hypoglycemic events, hospital length of stay, or 1‐year mortality between groups. Among patients with diabetes mellitus (DM), however, the insulin glargine group had a significantly higher percentage of admissions with at least 1 hypoglycemic event (45.5% vs 20%, P = 0.035). Conclusions RI‐in‐PN is recommended over insulin glargine because of the higher likelihood of achieving glycemic control and, in patients with DM, lower risk of hypoglycemic events. Large, randomized controlled trials are needed to further guide prescribing practice.

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Effectiveness of Regular Versus Glargine Insulin in Stable Critical Care Patients Receiving Parenteral Nutrition: A Randomized Controlled Trial

Abstract: These data suggest that, compared with regular insulin added to PN, glargine insulin results in similar glycemic control and rates of hyperglycemia and hypoglycemia in stable critical care patients.

Cited by 21 publications

References 45 publications

Insulin Regimens to Treat Hyperglycemia in Hospitalized Patients on Nutritional Support: Systematic Review and Meta-Analyses

Insulin Regimens to Treat Hyperglycemia in Hospitalized Patients on Nutritional Support: Systematic Review and Meta-Analyses

Management of hospitalized type 2 diabetes mellitus patients

Glycemic Control in Adult Surgical Patients Receiving Regular Insulin Added to Parenteral Nutrition vs Insulin Glargine: A Retrospective Chart Review

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