title: Comparison of intensive insulin therapy versus conventional glucose control in traumatic brain injury patients on parenteral nutrition: A pilot randomized clinical trial.
abstract: BACKGROUND
  Parenteral nutrition (PN) is a valuable life saving intervention, which can improve the nutritional status of hospitalized malnourished patients. PN is associated with complications including hyperglycemia. This study was conducted to compare two methods of blood glucose control in traumatic brain injury patients on PN.
  
  
  METHODS
  A randomized, open-label, controlled trial with blinded end point assessment was designed. Traumatic brain injury patients (GCS = 4-9) on PN, without diabetes, pancreatitis, liver disease, kidney complication, were participated. Patients were randomly assigned to receive continuous insulin infusion to maintain glucose levels between 4.4 mmol/l (80 mg/dl) and 6.6 mmol/l (120 mg/dl) (n = 13) or conventional treatment (n = 13). Patients in the conventional group were not received insulin unless glucose levels were greater than 10 mmol/l (>180 mg/dl). These methods were done to maintain normoglycemia in ICU. The primary outcome was hypo/hyperglycemic episodes. Other factors such as C-reactive protein, blood electrolytes, liver function tests, lipid profile and mid-arm circumference were compared.
  
  
  RESULTS
  Mean glucose concentration were significantly lower in IIT group (118 ± 28 mg/dl) vs conventional group (210 ± 31 mg/dl) (P < 0.01). No hypoglycemic episode occurred in two groups. Triglyceride (P = 0.02) and C-reactive protein (P = 0.001) was decreased in the IIT group, significantly. There were also significant differences in the electrolytes, with magnesium and phosphorus being lower in the IIT group (P = 0.05).
  
  
  CONCLUSIONS
  In this pilot study, blood glucose level, CRP and TG were lower in IIT group. Further data collection is warranted to reach definitive conclusions.
authors.affiliation: Department of Nutrition, Endoscopic and Minimally Invasive Surgery, and Cancer Research Centers, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Seyedeh Neda
authors.initials: SN
authors.lastname: Mousavi
authors.affiliation: Department of Nutrition, Endoscopic and Minimally Invasive Surgery, and Cancer Research Centers, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Nematy
authors.affiliation: Department of Nutrition, Endoscopic and Minimally Invasive Surgery, and Cancer Research Centers, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Abdolreza
authors.initials: A
authors.lastname: Norouzy
authors.affiliation: Department of Nutrition, Endoscopic and Minimally Invasive Surgery, and Cancer Research Centers, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Safarian
authors.affiliation: Department of Neurosurgery, Research Center of Orthopedic Surgery of Shahid Kamyab Hospital, Mashhad, Iran.
authors.forename: Fariborz
authors.initials: F
authors.lastname: Samini
authors.affiliation: Department of Neurosurgery, Research Center of Orthopedic Surgery of Shahid Kamyab Hospital, Mashhad, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Birjandinejad
authors.affiliation: Department of Life and Health Sciences, School of Sciences and Engineering, University of Nicosia, Cyprus.
authors.forename: Elena
authors.initials: E
authors.lastname: Philippou
authors.affiliation: Department of Neurosurgery, Research Center of Orthopedic Surgery of Shahid Kamyab Hospital, Mashhad, Iran.
authors.forename: Asghar
authors.initials: A
authors.lastname: Mafinejad
keywords: Hyperglycemia; hypoglycemia; intensive insulin therapy; parenteral nutrition
references.citation: JAMA. 2008 Aug 27;300(8):933-44
references.pmid: 18728267
references.citation: Mayo Clin Proc. 2003 Dec;78(12):1471-8
references.pmid: 14661676
references.citation: Acta Anaesthesiol Scand. 2007 Oct;51(9):1194-201
references.pmid: 17711565
references.citation: CMAJ. 2009 Apr 14;180(8):821-7
references.pmid: 19318387
references.citation: Ann Surg. 2005 May;241(5):759-67; discussion 767-8
references.pmid: 15849511
references.citation: N Engl J Med. 2001 Nov 8;345(19):1359-67
references.pmid: 11794168
references.citation: Curr Opin Anaesthesiol. 2010 Oct;23(5):539-43
references.pmid: 20689410
references.citation: Neurocrit Care. 2010 Dec;13(3):299-306
references.pmid: 20697836
references.citation: N Engl J Med. 2009 Mar 26;360(13):1283-97
references.pmid: 19318384
references.citation: J Trauma. 2010 Apr;68(4):904-11
references.pmid: 20032790
references.citation: J Trauma. 2005 Jan;58(1):47-50
references.pmid: 15674149
references.citation: Middle East J Anaesthesiol. 2010 Jun;20(5):659-66
references.pmid: 20803853
references.citation: Clin Nutr. 2009 Aug;28(4):387-400
references.pmid: 19505748
references.citation: N Z Med J. 2009 Jun 19;122(1297):17-24
references.pmid: 19648998
references.citation: J Clin Invest. 2005 Aug;115(8):2277-86
references.pmid: 16075063
references.citation: N Engl J Med. 2006 Feb 2;354(5):449-61
references.pmid: 16452557
references.citation: Gastroenterol Res Pract. 2011;2011:
references.pmid: 20811546