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Predictors of insulin requirements among hospitalized adults receiving parenteral nutrition

Kelly A Roehl1, Kristen Lach, Anne E Coltman

  • 1Rush University Medical Center, Chicago, Illinois.

JPEN. Journal of Parenteral and Enteral Nutrition
|June 18, 2013
PubMed

Insights

Parenteral nutrition (PN) insulin therapy is predicted by diabetes mellitus, obesity, ICU admission, and elevated blood glucose levels. These factors help identify patients needing insulin during PN treatment.

Area of Science:

  • Clinical Nutrition
  • Endocrinology
  • Quality Improvement

Background:

  • Parenteral nutrition (PN) is crucial for patients unable to receive nutrients orally.
  • Insulin therapy is often required during PN to manage hyperglycemia.
  • Predicting the need for PN insulin can optimize patient care and resource allocation.

Purpose of the Study:

  • To identify factors that predict the requirement for insulin therapy in patients receiving PN.
  • To improve the management of blood glucose levels in patients on PN.

Main Methods:

  • Retrospective analysis of 1388 adult patients receiving PN from 2009-2012.
  • Statistical analysis including chi-squared tests, Student t tests, and logistic regression.
  • Evaluation of demographic, medical, and PN-specific data to identify predictors.

Main Results:

  • Diabetes mellitus (DM) diagnosis, overweight/obesity (BMI ≥25.0 kg/m²), and ICU admission were significant predictors.
  • Elevated blood glucose (BG) on PN start day (>120 mg/dL) and mean BG during PN (>180 mg/dL) strongly correlated with insulin need.
  • Hemoglobin A1c (A1c) ≥5.7% was a significant predictor of PN insulin requirements.

Conclusions:

  • DM diagnosis, obesity, ICU admission, and specific blood glucose parameters predict the need for insulin during PN.
  • Early identification of these factors at PN initiation can guide insulin therapy decisions.
  • This quality improvement project provides valuable insights for managing hyperglycemia in PN patients.
Abstract

Keywords:
blood glucosediabeteshemoglobin A1cinsulinparenteral nutrition

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