Basal Versus Sliding-Scale Regular Insulin in Hospitalized Patients With Hyperglycemia During Enteral Nutrition Therapy

• Authors: Guillermo Umpierrez, Emory University
• Journal Title: Diabetes Care
• Volume: Volume 32, Number 4
• Publisher: American Diabetes Association | 2009-04, Pages 751-753
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.2337/dc08-2257
• Subjects: Health Sciences, Nutrition; Health Sciences, General

Abstract

A large number of hospitalized patients are in a catabolic state, with resultant increased caloric and protein needs. In such patients, inadequate oral intake can lead to undernutrition in 8 to 12 days. A collaborative study involving nutrition screening of 3,047 patients at admission to 33 hospitals reported that more than 50% of hospitalized patients were malnourished. Malnutrition is seen in several patient groups with diabetes, especially in the elderly and those with complications such as renal failure or neurological dysfunctions. Nutrition guidelines state that any patient unable to consume adequate nutrients orally (60% nutrition needs) for at least 5 days in the critically ill or 7 to 14 days in the general population should be a candidate for specialized nutrition support. Delayed feeding, resulting in malnutrition, may increase the risk of hospital complications (relative risk 1.60), higher mortality (12.4 vs. 4.7% in the well-nourished patients [relative risk 2.63]), and longer hospital stay (16.7 ± 24 vs. 10.1 ± 12 days in the nourished patients) and may increase hospital costs by 308%. A recent meta-analysis reported that providing early versus delayed nutrition support results in lower infectious complications and length of hospital stay. Nutritional support via enteral or parenteral nutrition in malnourished patients may prevent such complications. Although both forms of nutrition support have been shown to be successful in preventing the effects of starvation and malnutrition, oral or enteral nutrition is preferable to parenteral nutrition in clinical practice. Advantages of enteral feeding over parenteral nutrition include lower costs, avoidance of central catheter–related complications, its more physiological route, and its trophic effect on gastrointestinal cells.