title: Predictors of insulin requirements among hospitalized adults receiving parenteral nutrition.
abstract: OBJECTIVE
  The objective of this quality improvement project was to determine factors predictive of parenteral nutrition (PN) insulin therapy.
  
  
  METHODS
  Patients receiving PN at a tertiary care academic medical center between January 1, 2009, and December 1, 2012, 18 years or older were included. Variables collected included demographics, medical information, and PN-specific data. χ(2) and Student t tests were used to determine differences between patients who did and did not require PN insulin. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to determine associations between characteristics. Stepwise forward logistic regression was used determine the best predictors of PN insulin.
  
  
  RESULTS
  A total of 1388 patients were started on PN. After adjusting for potential confounders, strong associations existed between PN insulin requirements and diabetes mellitus (DM) diagnosis (OR, 8.90; 95% CI, 4.98-15.90, P < .001), overweight/obese status (body mass index ≥25.0 kg/m(2)) (OR, 2.12; 95% CI, 1.04-4.30, P = .04), intensive care unit (ICU) admission (OR, 1.79; 95% CI, 1.03-3.11, P = .04), blood glucose (BG) on day of PN start >120 mg/dL (OR, 2.32; 95% CI, 1.32-4.05, P = .003), mean BG >180 mg/dL while receiving PN (OR, 6.10; 95% CI, 2.18-17.04, P = .001), and hemoglobin A1c (A1c) ≥5.7% (OR, 3.18; 95% CI, 1.84-5.50, P < .001). Among variables available at PN initiation, DM diagnosis (P < .001), A1c ≥5.7% (P < .001), BG >120 mg/dL on PN start day (P < .001), and ICU admission (P < .001) predicted the need for PN insulin.
authors.affiliation: Rush University Medical Center, Chicago, Illinois.
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Roehl
authors.forename: Kristen
authors.initials: K
authors.lastname: Lach
authors.forename: Anne E
authors.initials: AE
authors.lastname: Coltman
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Bacon
authors.forename: Shubha
authors.initials: S
authors.lastname: Singh
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Peterson
authors.forename: Diane C
authors.initials: DC
authors.lastname: Sowa
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D003920:Diabetes Mellitus / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006760:Hospitalization; D006801:Humans; D006943:Hyperglycemia; D007328:Insulin / Q000627:therapeutic use*; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000628:therapy*; D016017:Odds Ratio; D010288:Parenteral Nutrition / Q000592:standards*; D058996:Quality Improvement
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin
keywords: blood glucose; diabetes; hemoglobin A1c; insulin; parenteral nutrition