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Risk Factors for Hypoglycemia in Inpatients with Total Parenteral Nutrition and Type 2 Diabetes: A Post HOC Analysis of the Insupar Study

2020; Elsevier BV; Volume: 26; Issue: 6 Linguagem: Inglês

10.4158/ep-2019-0482

1934-2403

Gabriel Olveira, Jose Abuín, Rafael García López, Sandra Herránz, José Manuel García‐Almeida, Katherine García-Malpartida, Mercedes Ferrer, Emilia Cáncer, Luis Miguel Luengo Pérez, Julia Álvarez, Carmen Aragón, María Jesús Lorca Ocón, Álvaro García‐Manzanares, Irene Bretón Lesmes, Pilar Serrano Aguayo, Natalia Pérez‐Ferre, Juan José López Gómez, Josefina Olivares, Carmen Arraiza, Cristina Tejera Pérez, Jorge D. Martín, A. Urioste-Fondo, Ángel Abad, María R. Alhambra, Ana Zugasti, Juan Carlos Parra, Sara Torrejón, María José Tapia,

Clinical Nutrition and Gastroenterology

Objective: Treatment of hyperglycemia with insulin is associated with increased risk of hypoglycemia in type 2 diabetes mellitus (T2DM) patients receiving total parenteral nutrition (TPN). The aim of this study was to determine the predictors of hypoglycemia in hospitalized T2DM patients receiving TPN. Methods: Post hoc analysis of the INSUPAR study, which is a prospective, open-label, multicenter clinical trial of adult inpatients with T2DM in a noncritical setting with indication for TPN. Results: The study included 161 patients; 31 patients (19.3%) had hypoglycemic events, but none of them was severe. In univariate analysis, hypoglycemia was significantly associated with the presence of diabetes with end-organ damage, duration of diabetes, use of insulin prior to admission, glycemic variability (GV), belonging to the glargine insulin group in the INSUPAR trial, mean daily grams of lipids in TPN, mean insulin per 10 grams of carbohydrates, duration of TPN, and increase in urea during TPN. Multiple logistic regression analysis showed that the presence of diabetes with end-organ damage, GV, use of glargine insulin, and TPN duration were risk factors for hypoglycemia. Conclusion: The presence of T2DM with end-organ damage complications, longer TPN duration, belonging to the glargine insulin group, and greater GV are factors associated with the risk of hypoglycemia in diabetic noncritically ill inpatients with parenteral nutrition. Abbreviations: ADA = American Diabetes Association; BMI = body mass index; CV% = coefficient of variation; DM = diabetes mellitus; GI = glargine insulin; GV = glycemic variability; ICU = intensive care unit; RI = regular insulin; T2DM = type 2 diabetes mellitus; TPN = total parenteral nutrition