Manoharan M, Mak M, Wong VW
OBJECTIVES: Admission hyperglycaemia was known to predict adverse outcomes during admission. However, to date, there were few studies examining the effects of hyperglycaemia on outcomes of in-patients with diabetes mellitus (DM) who receive enteral feeding. The aim of this study was to assess glycaemic profile of patients with DM who received enteral feeding and its impact on clinical outcomes.
RESEARCH DESIGN AND METHODS: A retrospective analysis of in-patients with pre-existing DM who received naso-gastric feeding (NGF) in the past 12 months was conducted. We recorded the blood glucose levels (BGL) of the patients prior, during and after cessation of enteral feeding. Hospital admission outcomes were also documented.
RESULTS: Among 49 patients included in this study, mean BGL during the period of NGF (NGF-BGL) was 10.7±3.2mmol/L. NGF-BGL was significantly higher in patients who were already on insulin therapy (13.3±3.0mmol/L vs 9.6±2.6, p<0.001). NGF-BGL was not associated with age, gender, diabetes duration, glycated haemoglobulin or the admitting team. There was also no association between NGF-BGL and length of stay (LOS) or death. Interestingly, there was weak positive association between LOS and mean BGL after NGF was ceased (R=0.312, p=0.041).
For patients on NGF who were seen by diabetes team, their NGF-BGL was not better. However, after NGF was ceased, glycaemic control was lower for patients who were reviewed by diabetes team (6.5±1.4 vs 9.2±4.4mmol/L, p=0.045).
CONCLUSIONS: Glycaemic control for in-patients with DM on NGF was poor. We found no association between NGF-BGL and clinical outcomes, but the sample could be too small to draw the conclusion. However, we demonstrated that patients who were reviewed by diabetes team had better glycaemic control after cessation of NGF, and the BGL post-NGF correlated better with hospital LOS. We believe the diabetes team plays a pivotal role in improving glycaemic control for in-patients on NGF.