Parenteral nutrition and insulin per protocol improve diabetes management after total pancreatectomy
Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited..
INTRODUCTION: Pancreatogenic diabetes develops in patients undergoing total pancreatectomy and complicates post-surgical management. The aim of this study was to compare parenteral nutrition (PN) with protocolled insulin treatment to intravenous glucose treatment after total pancreatectomy.
METHODS: This was a retrospective study of 97 patients undergoing total pancreatectomy between 2009 and 2014. Patients were divided into a PN cohort (n = 57) and a glucose cohort (n = 40). The PN cohort was given PN with one international unit (IU) rapid-acting insulin per 10 g of carbohydrate. The glucose cohort was given a continuous 5% glucose infusion with 2 IU rapid-acting insulin per 10 g of carbohydrate. Both cohorts were given insulin detemir 0.2 IU/kg/day.
RESULTS: Within the first 13 post-operative days, plasma glucose values were within the target range (4.0-10.0 mmol/l) in the PN cohort more frequently than in the glucose cohort (46% versus 42%, p = 0.01) without any increase in hypoglycaemia. Non-infectious complications occurred less frequently in the parenteral cohort than in the glucose cohort (23% versus 43%, p = 0.04). Infectious complications occurred in 19% versus 33% of patients, respectively (p = 0.14). The mean length of hospitalisation was 19.8 ± 12.7 versus 25.0 ± 21.5 days, p = 0.14.
CONCLUSIONS: After total pancreatectomy, PN with insulin treatment per protocol improves glycaemic control compared with glucose infusion and reduces the number of non-infectious post-operative complications without increasing hypoglycaemia.
FUNDING: none.
TRIAL REGISTRATION: not relevant.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2018 |
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| Erschienen: |
2018 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:65 |
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| Enthalten in: |
Danish medical journal - 65(2018), 4 vom: 04. Apr. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Andersen, Sakshi [VerfasserIn] |
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| Themen: |
Blood Glucose |
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| Anmerkungen: |
Date Completed 14.09.2018 Date Revised 14.09.2018 published: Print Citation Status MEDLINE |
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| Förderinstitution / Projekttitel: |
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| 100 | 1 | |a Andersen, Sakshi |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Parenteral nutrition and insulin per protocol improve diabetes management after total pancreatectomy |
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| 520 | |a Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. | ||
| 520 | |a INTRODUCTION: Pancreatogenic diabetes develops in patients undergoing total pancreatectomy and complicates post-surgical management. The aim of this study was to compare parenteral nutrition (PN) with protocolled insulin treatment to intravenous glucose treatment after total pancreatectomy | ||
| 520 | |a METHODS: This was a retrospective study of 97 patients undergoing total pancreatectomy between 2009 and 2014. Patients were divided into a PN cohort (n = 57) and a glucose cohort (n = 40). The PN cohort was given PN with one international unit (IU) rapid-acting insulin per 10 g of carbohydrate. The glucose cohort was given a continuous 5% glucose infusion with 2 IU rapid-acting insulin per 10 g of carbohydrate. Both cohorts were given insulin detemir 0.2 IU/kg/day | ||
| 520 | |a RESULTS: Within the first 13 post-operative days, plasma glucose values were within the target range (4.0-10.0 mmol/l) in the PN cohort more frequently than in the glucose cohort (46% versus 42%, p = 0.01) without any increase in hypoglycaemia. Non-infectious complications occurred less frequently in the parenteral cohort than in the glucose cohort (23% versus 43%, p = 0.04). Infectious complications occurred in 19% versus 33% of patients, respectively (p = 0.14). The mean length of hospitalisation was 19.8 ± 12.7 versus 25.0 ± 21.5 days, p = 0.14 | ||
| 520 | |a CONCLUSIONS: After total pancreatectomy, PN with insulin treatment per protocol improves glycaemic control compared with glucose infusion and reduces the number of non-infectious post-operative complications without increasing hypoglycaemia | ||
| 520 | |a FUNDING: none | ||
| 520 | |a TRIAL REGISTRATION: not relevant | ||
| 650 | 4 | |a Comparative Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 7 | |a Blood Glucose |2 NLM | |
| 650 | 7 | |a Hypoglycemic Agents |2 NLM | |
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| 700 | 1 | |a Andersen, Andreas |e verfasserin |4 aut | |
| 700 | 1 | |a Ringholm, Lene |e verfasserin |4 aut | |
| 700 | 1 | |a Hansen, Carsten Palnæs |e verfasserin |4 aut | |
| 700 | 1 | |a Storkholm, Jan |e verfasserin |4 aut | |
| 700 | 1 | |a Lillpers, Kerstin |e verfasserin |4 aut | |
| 700 | 1 | |a Schiøtz, Charlotte |e verfasserin |4 aut | |
| 700 | 1 | |a Mathiesen, Elisabeth Reinhardt |e verfasserin |4 aut | |
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