Parenteral nutrition and insulin per protocol improve diabetes management after total pancreatectomy

Sakshi Andersen; Andreas Andersen; Lene Ringholm; Carsten Palnæs Hansen; Jan Storkholm; Kerstin Lillpers; Charlotte Schiøtz; Elisabeth Reinhardt Mathiesen

Parenteral nutrition and insulin per protocol improve diabetes management after total pancreatectomy

Sakshi Andersen, Andreas Andersen, Lene Ringholm, Carsten Palnæs Hansen, Jan Storkholm, Kerstin Lillpers, Charlotte Schiøtz, Elisabeth Reinhardt Mathiesen

Institut for Klinisk Medicin

2 Citationer (Scopus)

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Abstract

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.

Originalsprog	Engelsk
Tidsskrift	Danish Medical Journal
Vol/bind	65
Udgave nummer	4
Antal sider	5
ISSN	1603-9629
Status	Udgivet - apr. 2018

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Parenteral nutrition and insulin per protocol improve diabetes management after total pancreatectomyForlagets udgivne version, 164 KBLicens: Ikke-specificeret

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Citationsformater

Andersen, S., Andersen, A., Ringholm, L., Hansen, C. P., Storkholm, J., Lillpers, K., Schiøtz, C., & Mathiesen, E. R. (2018). Parenteral nutrition and insulin per protocol improve diabetes management after total pancreatectomy. Danish Medical Journal, 65(4). http://ugeskriftet.dk/files/a5475_parenteral_nutrition_and_insulin_per_protocol_improve_diabetes_management_after_total_pancreatectomy.pdf

Andersen, S, Andersen, A, Ringholm, L, Hansen, CP, Storkholm, J, Lillpers, K, Schiøtz, C & Mathiesen, ER 2018, 'Parenteral nutrition and insulin per protocol improve diabetes management after total pancreatectomy', Danish Medical Journal, bind 65, nr. 4. <http://ugeskriftet.dk/files/a5475_parenteral_nutrition_and_insulin_per_protocol_improve_diabetes_management_after_total_pancreatectomy.pdf>

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title = "Parenteral nutrition and insulin per protocol improve diabetes management after total pancreatectomy",

abstract = "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.",

keywords = "Adenocarcinoma, Aged, Blood Glucose/metabolism, Chi-Square Distribution, Diabetes Mellitus/drug therapy, Female, Humans, Hypoglycemic Agents/administration & dosage, Infusions, Intravenous, Insulin/administration & dosage, Insulin Aspart, Length of Stay/statistics & numerical data, Male, Middle Aged, Pancreatectomy/adverse effects, Pancreatic Neoplasms/surgery, Parenteral Nutrition/methods, Postoperative Complications/drug therapy, Retrospective Studies, Statistics, Nonparametric",

author = "Sakshi Andersen and Andreas Andersen and Lene Ringholm and Hansen, {Carsten Paln{\ae}s} and Jan Storkholm and Kerstin Lillpers and Charlotte Schi{\o}tz and Mathiesen, {Elisabeth Reinhardt}",

note = "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.",

year = "2018",

month = apr,

language = "English",

volume = "65",

journal = "Danish Medical Journal",

issn = "1603-9629",

publisher = "Almindelige Danske Laegeforening",

number = "4",

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TY - JOUR

T1 - Parenteral nutrition and insulin per protocol improve diabetes management after total pancreatectomy

AU - Andersen, Sakshi

AU - Andersen, Andreas

AU - Ringholm, Lene

AU - Hansen, Carsten Palnæs

AU - Storkholm, Jan

AU - Lillpers, Kerstin

AU - Schiøtz, Charlotte

AU - Mathiesen, Elisabeth Reinhardt

N1 - 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.

PY - 2018/4

Y1 - 2018/4

N2 - 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.

AB - 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.

KW - Adenocarcinoma

KW - Aged

KW - Blood Glucose/metabolism

KW - Chi-Square Distribution

KW - Diabetes Mellitus/drug therapy

KW - Female

KW - Humans

KW - Hypoglycemic Agents/administration & dosage

KW - Infusions, Intravenous

KW - Insulin/administration & dosage

KW - Insulin Aspart

KW - Length of Stay/statistics & numerical data

KW - Male

KW - Middle Aged

KW - Pancreatectomy/adverse effects

KW - Pancreatic Neoplasms/surgery

KW - Parenteral Nutrition/methods

KW - Postoperative Complications/drug therapy

KW - Retrospective Studies

KW - Statistics, Nonparametric

M3 - Journal article

C2 - 29619926

SN - 1603-9629

VL - 65

JO - Danish Medical Journal

JF - Danish Medical Journal

IS - 4

ER -

Parenteral nutrition and insulin per protocol improve diabetes management after total pancreatectomy

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