title: Hyperglycemia During Home Parenteral Nutrition Administration in Patients Without Diabetes.
abstract: Parenteral nutrition (PN) is a life-sustaining therapy in appropriate clinical settings. In the hospital setting, some nondiabetic patients develop hyperglycemia and subsequently require long-term insulin while receiving PN. Whether similar hyperglycemia is seen in the outpatient setting is unclear.
  
  
  
  We studied patients enrolled in the Mayo Clinic Home Parenteral Nutrition (HPN) program between January 1, 2010, and December 31, 2012. Patients were excluded if they had diabetes mellitus type 2 (DM2), had previously received HPN, had taken corticosteroids, or were at risk for refeeding syndrome.
  
  
  
  Of 144 enrolled patients, 93 met inclusion criteria with 39 patients requiring the addition of insulin to HPN. The mean age of the insulin-requiring group (IR) was higher than that of the non-insulin-requiring group (NIR) (60.74 ± 13.62 years vs 48.97 ± 17.62 years, P < .001). There were 17 (44%) men in the IR group and 26 (48%) men in the NIR group. Mean blood glucose at baseline before starting the infusion was 131.82 ± 49.55 mg/dL in IR patients and 106.16 ± 59.01 mg/dL in NIR patients ( P = .03). In the stepwise multivariate analysis for assessing the risk for developing hyperglycemia, HR for age was 1.020 (1.010-1.031), P < .001.
  
  
  
  Hyperglycemia is a common finding with the use of PN in both the hospital and ambulatory setting in patients without a previous diagnosis of DM2. Age was the most significant predictor of the requirement of insulin in the present study. When hyperglycemia is managed appropriately with insulin therapy, the long-term complications can be minimized.
authors.affiliation: 1 Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota.|2 Second Department of Internal Medicine, Charles University Faculty of Medicine, Hradec Kralove, Czech Republic.
authors.forename: Jithinraj
authors.initials: J
authors.lastname: Edakkanambeth Varayil
authors.affiliation: 3 Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Siddhant
authors.initials: S
authors.lastname: Yadav
authors.affiliation: 4 Division of Endocrinology, Mayo Clinic, Rochester, Minnesota.
authors.forename: John M
authors.initials: JM
authors.lastname: Miles
authors.affiliation: 1 Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Akiko
authors.initials: A
authors.lastname: Okano
authors.affiliation: 3 Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Darlene G
authors.initials: DG
authors.lastname: Kelly
authors.affiliation: 1 Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota.|3 Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.|4 Division of Endocrinology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Hurt
authors.affiliation: 4 Division of Endocrinology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Manpreet S
authors.initials: MS
authors.lastname: Mundi
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood* / Q000453:epidemiology* / Q000209:etiology; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D016331:Parenteral Nutrition, Home / Q000009:adverse effects*; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000305:Adrenal Cortex Hormones; D001786:Blood Glucose; D007328:Insulin
keywords: home parenteral nutrition; home parenteral nutrition infusate; hyperglycemia; insulin requirement