(OR07-01-24) Continuous Glucose Monitoring in Adults With Short Bowel Syndrome Receiving Overnight Infusions of Home Parenteral Nutrition: Secondary Analysis of Observational Data

Objectives: Dysglycemia is a significant risk factor for infection and is common among consumers of home parenteral nutrition (HPN). However, for HPN consumers, glucose profiles are poorly characterized and factors influencing glucose control are unknown. The aim of this secondary analysis is to characterize glycemic profiles using continuous glucose monitors (CGM) among HPN users and to identify determinants that influence glucose control.

Methods: Twenty-four-hour glycemic profiles of 20 adults with short bowel syndrome without diabetes or taking glycemic-altering medications receiving nocturnal HPN infusions were assessed. Participants wore the Freestyle Libre Pro CGM monitor for one week. Derived glycemic metrics included mean daily glucose, standard deviation (SD) as a measure of glycemic variability, % time in range (TIR 70-140 mg/dL), % time above range (TAR >180 mg/dL), and % time below range (TBR < 70 mg/dL). HPN characteristics and lifestyle factors were obtained through self-report. Linear mixed effects models were used to analyze associations between each glycemic metric and determinant, adjusted for age, sex, BMI, and years receiving HPN. Significance was considered at p < 0.05.

Results: Participants had a mean age of 52 years, BMI of 21.4 kg/m², were 77% female and 95% white. Participants ran infusions 3–7 days per week and received HPN for 4 years. Notably, 60% ate by mouth and 30% were smokers. The population mean glucose was 96.95mg/dL (±12.27), SD 20.83mg/dL (±10.52), TIR 84.98% (±12.33), TBR 11.47% (±9.6), and TAR 0.97% (±3.43). HPN dextrose content and smoking status were associated with higher glycemic variability and TAR, whereas no associations were observed for HPN fat or amino acids content, rate and volume of infusions, days per week on HPN, and infusion duration, among other factors. Dextrose content was positively associated with SD (β = 0.047mg/dL (SE =0.015); p =0.007) and TAR (β =0.011% (SE =0.004); p =0.03). Additionally, current smoking was associated with higher SD (β = 10.6mg/dL (SE =3.6); p =0.01) and TAR (β = 3.4% (SE =0.8); p = 0.001).

Conclusions: The findings suggest that HPN dextrose content and smoking status may contribute to dysglycemia among HPN users. Further research in TPN reformulation and smoking cessation is needed to identify strategies to mitigate infection risk.

Funding Sources: ASPEN Rhoads Research Foundation