Glycemic Variation in Tumor Patients with Total Parenteral Nutrition

Abstract

Background: Hyperglycemia is associated with poor clinical outcomes and mortality in several patients. However, studies evaluating hyperglycemia variation in tumor patients receiving total parenteral nutrition (TPN) are scarce. The aim of this study was to assess the relationship between glycemia and tumor kinds with TPN by monitoring glycemic variation in tumor patients.

Methods: This retrospective clinical trial selected 312 patients with various cancer types, whose unique nutrition treatment was TPN during the monitoring period. All patients had blood glucose (BG) values assessed at least six times daily during the TPN infusion. The glycemic variation before and after TPN was set as the indicator to evaluate the factors influencing BG.

Results: The clinical trial lasted 7.5 ± 3.0 days adjusted for age, gender, family cancer history and blood types. There were six cancer types: Hepatic carcinoma (HC, 21.8%), rectal carcinoma (17.3%), colon carcinoma (CC, 14.7%), gastric carcinoma (29.8%), pancreatic carcinoma (11.5%), and duodenal carcinoma (DC, 4.8%). The patients were divided into diabetes and nondiabetes groups. No statistical differences in TPN glucose content between diabetes and nondiabetes groups were found; however, the tumor types affected by BG values were obvious. With increasing BG values, DC, HC and CC were more represented than other tumor types in this sequence in diabetic individuals, as well as in the nondiabetic group. BG was inclined to be more easily influenced in the nondiabetes group. Other factors did not impact BG values, including gender, body mass index, and TPN infusion duration time.

Conclusions: When tumor patients are treated with TPN, BG levels should be monitored according to different types of tumors, besides differentiating diabetes or nondiabetes patients. Special BG control is needed for DC, HC and CC in both diabetic and nondiabetic patients. If BG overtly increases, positive measurements are needed to control BG values. The ClinicalTrials.gov ID is NCT02024321.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1

Blood glucose value variations with different impacting factors (mean ± SE). Diagnosis (a), gender (c), insulin (e), BMI (g) and TPN duration (i) in diabetic patients. Diagnosis (b), gender (d), insulin (f), BMI (h) and TPN duration (j) in nondiabetic patients. HC: Hepatic carcinoma; CC: Colon carcinoma; DC: Duodenal carcinoma; GC: Gastric carcinoma; PC: Pancreatic carcinoma; RC: Rectal carcinoma. P value is the result of comparing the mean value in each stage. P value is calculated from one-way ANOVA. *P < 0.05. P1: Blood glucose levels pre-TPN; P2: Blood glucose levels within 24 h of TPN (within 24 h); P3: Blood glucose levels after during TPN infusion after 24 h (After 24 h).

Figure 2

Blood glucose values in diabetic and nondiabetic groups with or without insulin. Blood glucose values increases highly within 24 h and decreases after 24 h; however, the last values are higher than those obtained pre-TPN. Blood glucose levels in DC are highest in Figure 2a, 2c and 2d. Blood glucose levels in HC are highest in Figure 2b. HC: Hepatic carcinoma; CC: Colon carcinoma; DC: Duodenal carcinoma; GC: Gastric carcinoma; PC: Pancreatic carcinoma; RC: Rectal carcinoma.