Michele Gerard-Boncompain^1,2, Patrick Gelas^1,2, Madeleine Lauverjat², Catherine Peraldi², Abdoulaye Toure¹, Cecile Chambrier^1,2

¹Unité de Nutrition Clinique Intensive, Hospices Civils de Lyon, Lyon, France; ²Centre Agréé de Nutrition Parentérale à Domicile, Lyon, France

Background: Patients receiving cyclic nocturnal parenteral nutrition (PN) at home are exposed to intermittent large load of glucose (200 - 300g), and perhaps nocturnal hyperglycemia leading urinary losses of electrolytes and glucose.

Methods: Observational study to assess glucose homeostasis in patients on long term parenteral nutrition (HPN) for intestinal failure. Data recording: aetiologies of IF, anthropometry, albuminemia, history of diabetes, treatment (corticoid, insulin), parenteral nutrition, REE (indirect calorimetry). Blood samples were taken at the end of PN: glycemia, triglyceridemia, glycosalyted haemoglobin (HbA1c). Statistics: mean ± SD.

Results: 90 patients (44 women), age: 56±17 years. Anthropometry: women: weight: 53±11kg, height 159±6cm (BMI: 21±4), men: weight: 62±9kg, height: 172±6 cm (BMI: 21± 3). Albuminemia: 34.6±5.7g/l. Measured EER (76 patients): 24.4±5.0 Kcal/kg/d. Causes of HPN: short bowel syndrome: 55, miscanellous: 26, surgery of pancreas: 6, multivisceral transplantation: 2, kidney+ pancreas transplantation:1. History of diabetes: 8 patients (4 DID, 4 NDID), corticotherapy: 8. Duration of HPN: 74±72 months; 4.9±1.7 bags per week. PN composition per bag: total calories: 27.7±8.0 kcal/kg (1.16±28 REE), glucose: 4.12±1.40 g/kg, lipids: 0.90 ± 0.34 g/kg, azote: 0.16 ±0.05 g/kg. Glycemia: 4.46±1.02 mml/l (only 3 patients were hyperglycaemic >7 mml/l); triglyceridemia: 0.99±0.80 mml/l (n: <1,5mml/l). All patients HbA1c:5.44±0.72 %; non diabetics HbA1c: 5.41±0.72% and diabetic patients HbA1c: 5.70±0.71%. 8 patients need 2 or 3 types of insulin (6 patients with history of diabetes, 2 with pancreas surgery). Patients with a multivisceral graft has no diabetes despite corticotherapy

Conclusion: Glucose homeostasis isobtained in patients on cyclic HPN. HbA1c is normal in this population. All patients who require insulin therapy have history of diabetes or surgery of pancreas, despite parenteral nutrition,the control of their diabetes seems good.