Reducing Blood Glucose Testing Is Safe in Patients Receiving Parenteral Nutrition

• Published in: Nutrition in clinical practice Vol. 33; no. 6; p. 872
• Main Authors: Ratliff, Ashley, Nishnick, Amy, DeChicco, Robert, Lopez, Rocio
• Format: Journal Article
• Language: English
• Published: United States 01.12.2018
• Subjects: Adult; Aged; Blood Glucose - metabolism; Blood Glucose Self-Monitoring; Female; Glucose; Guideline Adherence; Humans; Hyperglycemia - blood; Hyperglycemia - etiology; Hypoglycemia - blood; Hypoglycemia - etiology; Male; Middle Aged; Parenteral Nutrition - adverse effects; Point-of-Care Systems; Practice Guidelines as Topic; blood glucose; hyperglycemia; cost savings; nutritional support; parenteral nutrition; quality improvement; glucose monitoring
• ISSN: 1941-2452
• DOI: 10.1002/ncp.10020

Hyperglycemia is a common adverse event associated with parenteral nutrition (PN); however, there is no consensus on optimal glucose monitoring. Unnecessary point-of-care (POC) blood glucose (BG) testing can result in additional healthcare cost and discomfort to the patient. This study's aim was to determine whether decreasing the frequency of POC glucose testing in patients receiving PN can reduce costs without increasing the frequency of glycemic events. This study examined adult, noncritically ill patients who require PN and are managed by a nutrition support team. Guidelines were developed for the initiation and discontinuation of POC BG monitoring. Pre-intervention and post-intervention data were collected for each patient, including daily POC glucose and glucose from the basic metabolic panel (BMP). Equivalency testing was completed for each group. Data were collected on 171 subjects (86 preguideline, 85 postguideline). The total number of POC tests per patient was significantly less in the postintervention period (median 23.0 vs 25.5; P = .011), as well as the average number of POC tests per patient per day (2.9 ± 1.4 vs 3.6 ± 1.4; P < .001). The average BMP glucose (126 mg/dL preintervention vs 129 mg/dL postintervention; P = .005) and the number of hypoglycemic and hyperglycemic events per 100 tests (both P < .001) were equivalent. Implementation of new guidelines resulted in decreased frequency of POC BG tests by 20%, which may impact cost savings and patient comfort in hospitalized patients receiving PN without increasing average BG level or glycemic events.