Endocrine Abstracts

Introduction: Recent consensus guidelines for the Joint British Diabetes Societies and the Endocrine Society cover the common clinical scenario of optimising glycaemic control in patients receiving enteral (NG/PEG), and total parenteral nutrition (TPN), although the approach recommended differs. Here, we outline an Irish tertiary referral centre experience, and compare with international guidance.

Methods: We extracted data from our electronic referral system, which captures all inpatient consultations, from May 2018-May 2024. This includes demographics, patient diagnosis (ICD-10 codes), referral information (free text), HbA1c at referral, and specialist opinion (including regimen recommended). Data was extracted to Excel and analysed using Stata version 16.0, using simple descriptive statistics.

Results: Over the 6-year study period, the inpatient diabetes service received 215 inpatient referrals for patients on TPN (39%) or NG/PEG feeding (61%). Mean age was 68 years (SD 13.5), and median HbA1c at referral was 53 mmol/mol (IQR 46-64). Type 2 diabetes accounted for 67% of referrals, 15% had type 1 diabetes, 8% had another type, and 9% did not have a confirmed diagnosis of diabetes. Multiple daily injection (MDI) insulin was the most popular regimen, being used in 28% overall, followed by sliding scale insulin alone (22%), and basal plus correction insulin (19%). IV insulin use was less common (9%). 19% continued oral medication. Twenty-five percent of referrals were on the same patient, at different times during their admission.

Conclusion: Enteral and parenteral feeding is a common indication for inpatient consultation. Multiple referrals on the same patient are common, indicating the complex nature of the clinical situation. Multiple different regimens are in use, with subcutaneous basal insulin and MDI regimens being the most popular in both type 1 and Type 2 diabetes. Further study, examining glycaemic targets achieved, with a view to developing a definitive institutional protocol would be desirable.