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Continuous glucose monitoring in adults with short bowel syndrome receiving overnight infusions of home parenteral nutrition

Abstract

Background/Objectives

Consumers of home parenteral nutrition (HPN) are susceptible to dysglycemia. The aim was to characterize 24-h glucose profiles of HPN consumers using continuous glucose monitors (CGM) and to identify factors that influence glucose.

Subjects/Methods

Glucose profiles of 20 adults with short bowel syndrome (SBS) without diabetes were assessed using the Freestyle Libre Pro CGM. Measures included mean 24-h glucose, coefficient of variation (%), % time in range (TIR 70–140 mg/dL), among others. HPN parameters and lifestyle behaviors were obtained from self-reports and validated surveys. Linear mixed-effects models were used to test associations with glycemic measures adjusted for age, sex, and BMI. Significance was considered at P < 0.05.

Results

Participants (77% female, age = 52 years, BMI = 21.4 kg/m², 95% white) had a 24-h mean and CV for glucose of 94.69 (8.96) mg/dL and 20.27%, respectively, and a mean TIR of 87.73%. Among non-daily HPN-dependent patients, the mean glucose and TIR were higher on days receiving HPN. Tapering HPN was associated with −6.882 (95% confidence interval = −12.436, −1.329) % lower CV, and higher HPN dextrose content per gram was associated with 0.039 (95% confidence interval = 0.008, 0.07) % higher CV. Smoking, more depressive symptoms, and higher insomnia severity showed associations with glucose levels and variability.

Conclusions

Metabolically stable HPN adult consumers have 24-h glucose measures comparable to healthy adults yet are notable for more time spent below range. The glucose profiles are influenced by HPN parameters such as tapering and dextrose and behaviors including smoking, depressive symptoms, and insomnia.

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Fig. 1: Glucose targets derived from continuous glucose monitor in adults with short bowel syndrome receiving overnight infusions of home parenteral nutrition.

Data availability

Participant-level data are available from the Mass General Brigham Human Research Office/Institutional Review Board at Mass General Brigham for researchers who meet the criteria for access to confidential data.

Code availability

The code described for this study is available upon request pending approval by the corresponding author. Researchers interested in reproducing or extending the analysis can request access by contacting the corresponding author.

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Acknowledgements

The Authors thank the research participants who contributed to this research.

Funding

This work was supported by the American Society for Parenteral and Enteral Nutrition (ASPEN) Rhoads Research Foundation. This work was also supported by the National Institute of Health [grant number R00HL153795 to HSD].

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  1. Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Priyasahi Saravana, Meghan Lau & Hassan S. Dashti

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  1. Priyasahi Saravana
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Contributions

Priyasahi Saravana and Hassan S Dashti contributed to the conception/design of the research; the acquisition, analysis, and interpretation of the data; Meghan Lau contributed to the analysis of the data; Priyasahi Saravana, Meghan Lau, and Hassan S Dashti drafted the manuscript; all authors critically revised the manuscript; and Hassan S Dashti agrees to be fully responsible for ensuring the integrity and accuracy of the work. All authors read and approved the final manuscript.

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Hassan S. Dashti.

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The authors declare no competing interests.

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This research was performed in accordance with the Declaration of Helsinki and was approved by the Mass General Brigham Institutional Review Board (#2020P003741). Informed consent was obtained from all participants prior to study procedures.

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Saravana, P., Lau, M. & Dashti, H.S. Continuous glucose monitoring in adults with short bowel syndrome receiving overnight infusions of home parenteral nutrition.
Eur J Clin Nutr (2024). https://doi.org/10.1038/s41430-024-01548-z

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  • Received: 23 May 2024

  • Revised: 08 November 2024

  • Accepted: 13 November 2024

  • Published: 23 November 2024

  • DOI: https://doi.org/10.1038/s41430-024-01548-z

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