Nutrition and Hyperglycemia Management in the Inpatient Setting (Meals on Demand, Parenteral, or Enteral Nutrition)

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

1. 1.
   •• Diabetes Care in the Hospital. Diabetes Care 2017; 40 Suppl 1: S120-S127. Up-to date concise reference guding management of hyperglycemia in hospitalized patients.Google Scholar
2. 2.
   Ryan DB, Swift CS. The mealtime challenge: nutrition and glycemic control in the hospital. Diabetes Spectrum. 2014;27:163–8.CrossRefPubMedPubMedCentralGoogle Scholar
3. 3.
   Curll M, Dinardo M, Noschese M, Korytkowski MT. Menu selection, glycaemic control and satisfaction with standard and patient- controlled consistent carbohydrate meal plans in hospitalized patients with diabetes. Qual Saf Health Care. 2010;19:355–9.CrossRefPubMedGoogle Scholar
4. 4.
   Goldman DP, Variana M, Romley JA. The emerging improtance of patient amenities in hospital care. N Engl J Med. 2010;363:2185–7.CrossRefPubMedPubMedCentralGoogle Scholar
5. 5.
   McKnight KA, Carter L. From trays to tube feeding: overcoming the challenge of hospital nutrition and glycemic control. Diabetes Spectrum. 2008;21:233–40.CrossRefGoogle Scholar
6. 6.
   Hirose M, Yamanaka H, Ishikawa E, Sai A, Kawamura T. Easy and flexible carbohydrate counting sliding scale reduces blood glucose of hospitalized diabetic pateint in safety. Diabetes Res Clin Prac. 2011;93:404–9.CrossRefGoogle Scholar
7. 7.
   Dungan KM, Sagrilla C, Abdel-Rasoul M, Osei K. Prandial insulin dosing using carbohydrate counting technique in hispitalized patient with type 2 diabetes. Diabetes Care. 2013;36:3476–82.CrossRefPubMedPubMedCentralGoogle Scholar
8. 8.
   Thurber KM, Dierkhising RA, Reiland SA, Pearson KK, Smith SA, O’Meara JG. Mealtime insuin dosing by carbohydrate counting in hospitalized cardiology patients: a retrospective cohort study. Diabetes Technol Ther. 2015;11:1–7.Google Scholar
9. 9.
   Cohen LS, Sedhom L, Salifu M, Friedman EA. Inpatient diabetes management: examining morning practice in an acute care setting. Diabetes Educator. 2007;33:483–92.CrossRefPubMedGoogle Scholar
10. 10.
    Korytkowski M, Draznin B, Drincic A. Food, fasting, insulin and glycemic control in the hospital. In: DrazninB, editor. Managing diabetes and hyperglycemia in the hospital setting. Alexandria: The American Diabetes Association; 2016. P 70–83.Google Scholar
11. 11.
    Pleva M, Mirtallo JM, Steinberg SM. Hyperglycemic events in non-intensive care unit patients receiving parenteral nutrition. Nutr Clin Pract. 2009;24:626–34.CrossRefPubMedGoogle Scholar
12. 12.
    •• Olveira G, Tapia MJ, Ocón J, et al. Prevalence of diabetes, prediabetes, and stress hyperglycemia: insulin therapy and metabolic control in patients on total parenteral nutrition (prospective multicenter study). Endocr Pract. 2015;21(1):59–67. Large prospective multicenter trial examining the prevalence of diabetes, prediabetes, and stress hyperglycemia prior to initiation of PN therapy and the subsequent development of hyperglycemia.CrossRefPubMedGoogle Scholar
13. 13.
    Arinzon Z, Shabat S, Shuval I, et al. Prevalence of diabetes mellitus in elderly patients received enteral nutrition long-term care service. Arch Gerontol Geriatr. 2008a;47:383–93.CrossRefPubMedGoogle Scholar
14. 14.
    Pancorbo-Hidalgo PL, Garcia-Fernandez FP, Ramirez-Perez C. Complications associated with enteral nutrition by nasogastric tube in an internal medicine unit. J Clin Nurs. 2001a;10:482–90.CrossRefPubMedGoogle Scholar
15. 15.
    Dungan KM, Braithwaite SS, Preiser JC. Stress hyperglycaemia. Lancet. 2009a;373:1798–807.CrossRefPubMedPubMedCentralGoogle Scholar
16. 16.
    Lelkes BR, Unsworth PI. Lelkes. Reactive oxygen species, apoptosis and altered NGF induced signaling in PC12 pheochromocytoma cells cultured in elevated glucose: an in vitro cellular model for diabetic neuropathy. Neurotox Res. 2001;3:189–203.CrossRefPubMedGoogle Scholar
17. 17.
    Ling PR, Mueller C, Smith RJ, et al. Hyperglycemia induced by glucose infusion causes hepatic oxidative stress and systemic inflammation, but not STAT3 or MAP kinase activation in liver in rats. Metabolism. 2003;52:868–74.CrossRefPubMedGoogle Scholar
18. 18.
    Kersten JR, Schmeling TJ, Orth KG, Pagel PS, Warltier DC. Acute hyperglycemia abolishes ischemic preconditioning in vivo. Am J Phys. 1998;275:H721–5.Google Scholar
19. 19.
    Petrov MS, Zagainov VE. Influence of enteral versus parenteral nutrition on blood glucose control in acute pancreatitis: a systematic review. Clin Nutr. 2007;26:514.CrossRefPubMedGoogle Scholar
20. 20.
    Suchner U, Senftleben U, Eckart T, et al. Enteral versus parenteral nutrition: effects on gastrointestinal function and metabolism. Nutrition. 1996;12:13–22.CrossRefPubMedGoogle Scholar
21. 21.
    Cheung NW, Napier B, Zaccaria C, Fletcher JP. Hyperglycemia is associated with adverse outcomes in patients receiving total parenteral nutrition. Diabetes Care. 2005;28:2367–71.CrossRefPubMedGoogle Scholar
22. 22.
    Lin LY, Lin HC, Lee PC, Ma WY, Lin HD. Hyperglycemia correlates with outcomes in patients receiving total parenteral nutrition. Am J Med Sci. 2007;333:261–5.CrossRefPubMedGoogle Scholar
23. 23.
    Pasquel FJ, Spiegelman R, McCauley M, et al. Hyperglycemia during total parenteral nutrition: an important marker of poor outcome and mortality in hospitalized patients. Diabetes Care. 2010;33:739–41.CrossRefPubMedGoogle Scholar
24. 24.
    Sarkisian S, Fenton TR, Shaheen AA, Raman M. Parenteral nutrition-associated hyperglycemia in noncritically ill inpatients is associated with higher mortality. Can J Gastroenterol. 2010;24:453–7.CrossRefPubMedPubMedCentralGoogle Scholar
25. 25.
    • Olveira G, Tapia MJ, Ocón J, et al. Parenteral nutrition-associated hyperglycemia in non- critically ill inpatients increases the risk of in-hospital mortality (multicenter study). Diabetes Care. 2013;36(5):1061–6. Largest study looking at hyperglycemia during PN and mortality in non critically ill patients CrossRefPubMedPubMedCentralGoogle Scholar
26. 26.
    • Farrokhi F, Chandra P, Smiley D, Pasquel FJ, Peng L, Newton CA, et al. Glucose variability is an independent predictor of mortality in hospitalized patients treated with total parenteral nutrition. Endocr Pract. 2014;20:41–5. This is the only study that looked at clinical outcomes and glycemic variability in patients receiving PN.CrossRefPubMedGoogle Scholar
27. 27.
    Lee H, Koh SO, Park MS. Higher dextrose delivery via TPN related to the development of hyperglycemia in non-diabetic critically ill patients. Nutr Res Pract. 2011;5(5):450–4.CrossRefPubMedPubMedCentralGoogle Scholar
28. 28.
    Gosmanov AR, Umpierrez GE. Management of hyperglycemia during enteral and parenteral nutrition therapy. Curr Diab Rep. 2013 Feb;13(1):155–62.CrossRefPubMedPubMedCentralGoogle Scholar
29. 29.
    Ahrens CL, Barletta JF, Kanji S, Tyburski JG, Wilson RF, Janisse JJ, et al. Effect of low-calorie parenteral nutrition on the incidence and severity of hyperglycemia in surgical patients: a randomized, controlled trial. Crit Care Med. 2005;33:2507–12.CrossRefPubMedGoogle Scholar
30. 30.
    •• McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, et al. The Society of Critical Care Medicine and the American Society for Parenteral and Enteral Nutrition Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). J Parenter Enteral Nutr. 2016;40:159–211. The latest guidelines reviewing the evidence beyond appropriate use of EN and PN support.Google Scholar
31. 31.
    Valero MA, León-Sanz M, Escobar I, Gomis P, de la Cámara A, Moreno JM. Evaluation of non-glucose carbohydrates in parenteral nutrition for diabetic patients. Eur J Clin Nutr. 2001 Dec;55(12):1111–6.CrossRefPubMedGoogle Scholar
32. 32.
    Opara EC, Petro A, Tevrizian A, et al. L-Glutamine supplementation of a high fat diet reduces body weight and attenuates hyperglycemia and hyperinsulinemia in C57BL/6J mice. J Nutr. 1996;126:273–9.PubMedGoogle Scholar
33. 33.
    Grau T, Bonet A, Minambres E, et al. The effect of L-alanyl-L-glutamine dipeptide supplemented total parenteral nutrition on infectious morbidity and insulin sensitivity in critically ill patients. Crit Care Med. 2011;39:1263–8.CrossRefPubMedGoogle Scholar
34. 34.
    Heyland D, Muscedere J, Wischmeyer PE, et al. A randomized trial of glutamine and antioxidants in critically ill patients. N Engl J Med. 2013;368(16):1489–97.CrossRefPubMedGoogle Scholar
35. 35.
    Lidder P, Flanagan D, Fleming S, et al. Combining enteral with parenteral nutrition to improve postoperative glucose control. Br J Nutr. 2010;103:1635–41.CrossRefPubMedGoogle Scholar
36. 36.
    Neff K, Donegan D, MacMahon J, O'Hanlon C, Keane N, Agha A, et al. Management of parenteral nutrition associated hyperglycaemia: a comparison of subcutaneous and intravenous insulin regimen. Ir Med J. 2014 May;107(5):141–3.Google Scholar
37. 37.
    Sajbel TA, Dutro MP, Radway PR. Use of separate insulin infusions with total parenteral nutrition. J Parenter Enter Nutr. 1987;11:97–9.CrossRefGoogle Scholar
38. 38.
    Overett TK, Bistrian BR, Lowry SF, Hopkins BS, Miller D, Blackburn GL. Total parenteral nutrition in patients with insulin-requiring diabetes mellitus. J Am Coll Nutr. 1986;5(1):79–89.CrossRefPubMedGoogle Scholar
39. 39.
    McMahon MM. Management of parenteral nutrition in acutely ill patients with hyperglycemia. Nutr Clin Pract. 2004;19:120–8.CrossRefPubMedGoogle Scholar
40. 40.
    Jakoby MG, Nannapaneni N. An insulin protocol for management of hyperglycemia in patients receiving parenteral nutrition is superior to ad hoc management. JPEN J Parenter Enteral Nutr. 2012;36:183–8.CrossRefPubMedGoogle Scholar
41. 41.
    • Hakeam HA, Mulia HA, Azzam A, Amin T. Glargine insulin use versus continuous regular insulin in diabetic surgical noncritically ill patients receiving parenteral nutrition: randomized controlled study. JPEN J Parenter Enteral Nutr 2016; pii:0148607116644710. This is the only RCT that compared two different treatment approaches.Google Scholar
42. 42.
    Nauck MA, Walberg J, Vethacke A, El-Ouaghlidi A, Senkal M, Holst JJ, et al. Blood glucose control in healthy subject and patients receiving intravenous glucose infusion or total parenteral nutrition using glucagon-like peptide 1. Regul Pept. 2004;118:89–97.CrossRefPubMedGoogle Scholar
43. 43.
    Umpierrez GE, Hellman R, Korytkowski MT, Kosiborod M, Maynard GA, Montori VM, et al., Endocrine Society. Management of hyperglycemia in hospitalized patients in non-critical care setting: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2012 Jan;97(1):16–38. doi: 10.1210/jc.2011-2098.
44. 44.
    Maynard G et al; Society of Hospital Medicine Glycemic Control Implementation guide 2016. Section V.3. Subcutaneous insulin order sets and protocols: effective design and implementation strategies. 78–91.Google Scholar
45. 45.
    Arinzon Z, Shabat S, Shuval I, et al. Prevalence of diabetes mellitus in elderly patients received enteral nutrition long-term care service. Arch Gerontol Geriatr. 2008b;47:383–93.CrossRefPubMedGoogle Scholar
46. 46.
    Pancorbo-Hidalgo PL, Garcia-Fernandez FP, Ramirez-Perez C. Complications associated with enteral nutrition by nasogastric tube in an internal medicine unit. J Clin Nurs. 2001b;10:482–90.CrossRefPubMedGoogle Scholar
47. 47.
    Umpierrez G, Isaacs S, Bazargan N, You X, Thaler L, Kitabchi A. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab. 2002;87:978–82.CrossRefPubMedGoogle Scholar
48. 48.
    Ertorer ME, Haydarededeoglu FE, Anaforglu I. Newly diagnosed hyperglycemia and stress hyperglycemia in a coronary intensive care unit. Diabetes Res Clin Pract. 2010;90:8–14.CrossRefPubMedGoogle Scholar
49. 49.
    Deane AM, Rayner CK, Keeshan A, et al. The effects of critical illness on intestinal glucose sensing, transporters, and absorption. Crit Care Med. 2014;42:57–65.CrossRefPubMedGoogle Scholar
50. 50.
    Bharucha AE, Camilleri M, Burton DD, et al. Increased nutrient sensitivity and plasma concentrations of enteral hormones during duodenal nutrient infusion in functional dyspepsia. Am J Gastroenterol. 2014;109:1910–20.CrossRefPubMedPubMedCentralGoogle Scholar
51. 51.
    Marathe CS, Rayner CK, Bound M, et al. Small intestinal glucose exposure determines the magnitude of the incretin effect in health and type 2 diabetes. Diabetes. 2014;63:2668–75.CrossRefPubMedGoogle Scholar
52. 52.
    Dungan KM, Braithwaite SS, Preiser JC. Stress hyperglycaemia. Lancet. 2009b;373:1798–807.CrossRefPubMedPubMedCentralGoogle Scholar
53. 53.
    Lopez Teros MT, Ramirez CF, Aleman-Mateo H. Hyperinsulinemia is associated with the loss of appendicular skeletal muscle mass at 4.6 year follow-up in older men and women. Clin Nutr. 2015;34:931–6.CrossRefPubMedGoogle Scholar
54. 54.
    De Ferranti S, Mozaffarian D. The perfect storm: obesity, adipocyte dysfunction, and metabolic consequences. Clin Chem. 2008;54:945–55.CrossRefPubMedGoogle Scholar
55. 55.
    Donath MY, Shoelson SE. Type 2 diabetes as an inflammatory disease. Nat Rev Immunol. 2011;11:98–107.CrossRefPubMedGoogle Scholar
56. 56.
    Craig LD, Nicholson S, Silverstone FA, Kennedy RD. Use of a reduced-carbohydrate, modified-fat enteral formula for improving metabolic control and clinical outcomes in long-term care residents with type 2 diabetes: results of a pilot trial. Nutrition. 1998;14:529–34.CrossRefPubMedGoogle Scholar
57. 57.
    Brown B, Roehl K, Betz M. Enteral nutrition formula selection: current evidence and implications for practice. Nutr Clin Pract. 2015;30:72–85.CrossRefPubMedGoogle Scholar
58. 58.
    Visek J, Zourek M, Lacigova S, Rusavy Z. Influence of fiber on glycemic index of enteral nutrition. JPEN J Parenter Enteral Nutr. 2007;31:72–85.CrossRefGoogle Scholar
59. 59.
    Leon-Sanz M, Garcia-Luna PP, Sanz-Paris A, et al. Glycemic and lipid control in hospitalized type 2 diabetic patients: evaluation of 2 enteral nutrition formulas (low carbohydrate-high monounsaturated fat vs high carbohydrate). J Parenter Enter Nutr. 2005;29:21–9.Google Scholar
60. 60.
    Elia M, Ceriello A, Laube H, et al. Enteral nutritional support and use of diabetes-specific enteral formulas for patients with diabetes: a systematic review and meta-analysis. Diabetes Care. 2005;28:2267–79.CrossRefPubMedGoogle Scholar
61. 61.
    Alish CJ, Garvey WT, Maki KC, et al. A diabetes specific formula improves glycemic variability in patients with type 2 diabetes. Diabetes Technol Ther. 2010;12:419–25.CrossRefPubMedGoogle Scholar
62. 62.
    Vaisman N, Lansink M, Rouws CH, et al. Tube feeding with a diabetes-specific feed for 12 weeks improves glycaemic control in type 2 diabetes patients. Clin Nutr. 2009;28:549–55.CrossRefPubMedGoogle Scholar
63. 63.
    Pohl M, Mayr P, Mertl-Roetzer M, et al. Glycemic control in patients with type 2 diabetes mellitus with a disease-specific enteral formula: stage II of a randomized, controlled multicenter trial. J Parenter Enter Nutr. 2009;33:37–49.CrossRefGoogle Scholar
64. 64.
    Pohl M, Mayr P, Mertl-Roetzer M, et al. Glycaemic control in type II diabetic tube-fed patients with a new enteral formula low in carbohydrates and high in monounsaturated fatty acids: a randomized controlled trial. Eur J Clin Nutr. 2005;59:1221–32.CrossRefPubMedGoogle Scholar
65. 65.
    Yokoyama J, Someya T, Yoshhihara R, Ishii H. Effects of high-monounsaturated fatty acid enteral formula vs high-carbohydrate enteral formula on plasma glucose concentration and insulin secretion in healthy individuals and diabetic patients. J Int Med Res. 2008;36:137–46.CrossRefPubMedGoogle Scholar
66. 66.
    Mori Y, Ohta T, Tanaka T, Morohoshi Y, Matsuura K, et al. Effects of a low-carbohydrate diabetes-specific formula in tpe 2 diabetic patients during tube feeding evaluated by continuous glucose monitoring. e-SPEN, Eur J Clin Nutr Metab. 2011;6:e68–73.CrossRefGoogle Scholar
67. 67.
    Ojo O, Brooke J. Evaluation of the role of enteral nutrition in managing patients with diabetes: a systematic review. Nutrients. 2014;6:5142–52.CrossRefPubMedPubMedCentralGoogle Scholar
68. 68.
    Mesejo A, Acosta JA, Ortega C, et al. Comparison of a high-protein disease-specific enteral formula with a high-protein enteral formula in hyperglycemic critically ill patients. Clin Nutr. 2003;22:295–305.CrossRefPubMedGoogle Scholar
69. 69.
    • Mesejo A, Montejo-Gonzalez JC, Vaquerizo-Alonso C, Lobo-Tamer G, Zabarte-Martinez M, et al. Diabetes-specific enteral nutrition formula in hyperglycemic, mechanically ventilated, critically ill patients: a prospective, open-label, blind-randomized, multicenter study. Critical Care. 2015;19:390. Investigation into the role DSF EN has at improving glycemic outcomes when utilized in critical care patients. CrossRefPubMedPubMedCentralGoogle Scholar
70. 70.
    Sanz-Paris A, Boj-Carceller D, Lardies-Sanchez B, Perez-Fernandez L, Cruz-Jentoft AJ. Health-care costs, glycemic control and nutritional status in malnourished older diabetics treated with a hypercaloric diabetes-specific enteral nutritional formula. Nutrients. 8:153.Google Scholar
71. 71.
    Han YY, Lai SR, Partridge JS, Wang MY, Sulo S, et al. The clinical and economic impact of the use of diabetes-specific enteral formula on ICU patients with type 2 diabetes. Clin Nutr. 2016; doi: 10.1016/j.clnu.2016.09.027.
72. 72.
    McMahon MM, Nystrom E, Braunschweig C, Miles J, Compher C. A.S.P.E.N. clinical guidelines: nutrition support of adult patients with hyperglycemia. J Parenter Enter Nutr. 2013;37:23–36.CrossRefGoogle Scholar
73. 73.
    • Barazzoni R, et al. Carbohydrates and insulin resistance in clinical nutrition: recommendations from the ESPEN expert group. Clin Nutr. 2016; doi: 10.1016/j.Clnu.2016.09.010. Recent guidelines published recommending the use of DSF EN in patients as a means for glycemic management.
74. 74.
    Brunkhorst FM, Engel C, Bloos F, et al. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med. 2008;358:125–39.CrossRefPubMedGoogle Scholar
75. 75.
    De La Rosa GDC, Donado JH, Restrepo AH, et al. Strict glycaemic control in patients hospitalized in a mixed medical and surgical intensive care unit: a randomized clinical trial. Crit Care. 2008;12:R120.CrossRefGoogle Scholar
76. 76.
    Arabi YM, Dabbagh OC, Tamim HM, et al. Intensive versus conventional insulin therapy: a randomized controlled trial in medical and surgical critically ill patients. Crit Care Med. 2008;36:3190–7.CrossRefPubMedGoogle Scholar
77. 77.
    Preiser JC, Devos P, Ruiz-Santana S, et al. A prospective randomized multi-centre controlled trial on tight glucose control by intensive insulin therapy in adult intensive care units: the Glucontrol study. Intensive Care Med. 2009;35:1738–48.CrossRefPubMedGoogle Scholar
78. 78.
    NICE-SUGAR Study Investigators. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360:1283–97.CrossRefGoogle Scholar
79. 79.
    Marik PE, Preiser JC. Toward understanding tight glycemic control in the ICU. Chest. 2010;137:544–51.CrossRefPubMedGoogle Scholar
80. 80.
    Korytkowski MT, Salata RJ, Koerbel GL, et al. Insulin therapy and glycemic control in hospitalized patients with diabetes during enteral nutrition therapy: a randomized controlled clinical trial. Diabetes Care. 2009;32:594–6.CrossRefPubMedPubMedCentralGoogle Scholar
81. 81.
    Cook A, Burkitt D, McDonald L, Sublett L. Evaluation of glycemic control using NPH insulin sliding scale vs insulin aspart sliding scale in continuously tube-fed patients. Nutr Clin Pract: Off Publ Am Soc Parenter Enter Nutr. 2009;24:718–22.CrossRefGoogle Scholar
82. 82.
    Hsia E, Seggelke SA, Gibbs J, et al. Comparison of 70/30 biphasic insulin with glargine/lispro regimen in non-critically ill diabetic patients on continuous enteral nutrition therapy. Nutr Clin Pract: Off Publ Am Soc Parenter Enter Nutr. 2011;26:714–7.CrossRefGoogle Scholar
83. 83.
    • Pasquel FJ, Gianchandani R, Rubin DJ, Dungan KM, Anzola I, et al. Efficacy of sitagliptin for the hospital management of general medicine and surgery patients with type 2 diabetes: a multicentre, prospective, open-label, non-inferiority randomised trial. Lancet Diabetes Endocrinol. 2016; doi: 10.1016/s2213-8587(16)30402-8. Investigation into the role of oral hypoglycemic agents utilized in combination with basal insulin for inpatient glycemic management of non-critical care patients.