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Insulin Regimens to Treat Hyperglycemia in Hospitalized Patients on Nutritional Support: Systematic Review and Meta-Analyses
- Source :
- Annals of nutritionmetabolism. 71(3-4)
- Publication Year :
- 2017
-
Abstract
- Background: The best insulin regimen to treat hyperglycemia in hospitalized patients on nutritional support (NS) is unclear. Methods: We searched electronic databases to identify cohort studies or randomized clinical trials in order to evaluate the efficacy of different insulin regimens used to treat hyperglycemia in hospitalized patients on NS on diverse outcomes: mean blood glucose (MBG), hypoglycemia, length of stay in hospital, and mortality. Results: Seventeen studies from a total of 5,030 were included. Enteral Group included 8 studies; 1,203 patients using rapid, glargine, NPH, or Premix insulin; MBG 108-225 mg/dL; hypoglycemia 0-13%. In indirect meta-analyses, NPH insulin ranked best for glucose control (MD 95% CI -2.50 mg/dL [2.65 to -2.35]). Parenteral Group included 4 studies; 228 patients using regular and glargine or NPH insulin; MBG 137-202 mg/dL; hypoglycemia 0-40%. In meta-analyses comparing regular insulin added to parenteral nutrition bag with glargine, MBG (MD 95% CI -3.78 mg/dL [-11.93 to 4.37]; I2 = 0%) or hypoglycemia frequency (RR 95% CI 1.37 [0.43-4.32]; I2 = 70.7%) did not differ. The description related to hospital length of stay and mortality was inconsistent between groups. Conclusions: The best insulin regimen to treat hyperglycemia in hospitalized patients on NS has not been established; best results using insulin regimens with NPH in enteral nutrition do not seem to be clinically relevant.
- Subjects :
- 0301 basic medicine
Blood Glucose
medicine.medical_specialty
Parenteral Nutrition
medicine.medical_treatment
Insulin, Isophane
Medicine (miscellaneous)
Insulin Glargine
NPH insulin
Hypoglycemia
Enteral administration
law.invention
03 medical and health sciences
0302 clinical medicine
Randomized controlled trial
law
Internal medicine
medicine
Humans
Hypoglycemic Agents
Insulin
030212 general & internal medicine
Hospital Mortality
Intensive care medicine
Inpatients
030109 nutrition & dietetics
Nutrition and Dietetics
business.industry
Nutritional Support
Length of Stay
medicine.disease
Parenteral nutrition
Hyperglycemia
Regular insulin
business
Cohort study
Subjects
Details
- ISSN :
- 14219697
- Volume :
- 71
- Issue :
- 3-4
- Database :
- OpenAIRE
- Journal :
- Annals of nutritionmetabolism
- Accession number :
- edsair.doi.dedup.....971b8ce252c0c14b83a9ed7cb7e3be25