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Endocr Pract. 2015 Jan;21(1):59-67. doi: 10.4158/EP13441.OR.

Prevalence of diabetes, prediabetes, and stress hyperglycemia: insulin therapy and metabolic control in patients on total parenteral nutrition (prospective multicenter study).

Author information

1
Unidad de Gestión Clínica de Endocrinología y Nutrición, IBIMA, Hospital Regional Universitario de Málaga/Universidad de Málaga, Malaga, Spain CIBERDEM, CIBER of Diabetes and Associated Metabolic Diseases (CB07/08/0019), Instituto de Salud Carlos III, Spain.
2
Unidad de Gestión Clínica de Endocrinología y Nutrición, IBIMA, Hospital Regional Universitario de Málaga/Universidad de Málaga, Malaga, Spain.
3
Endocrinology and Nutrition Service, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
4
Endocrinology and Nutrition Service, Complejo Asistencial Universitario de León, Spain.
5
Endocrinology and Nutrition Service, Complejo Hospitalario de Jaén, Spain.
6
Endocrinology and Nutrition Service, Hospital Son Llàtzer (Palma de Mallorca), Spain.
7
Endocrinology and Nutrition Service, Hospital General Mancha Centro, Alcázar de San Juan, Ciudad-Real, Spain.
8
Endocrinology and Nutrition Service, Complejo Hospitalario Universitario de Albacete, Spain.
9
Endocrinology and Nutrition Service, Hospital Clínico San Carlos, Madrid, Spain.
10
Clinical Nutrition Unit, University Hospital Vall d'Hebron, Barcelona, Spain.
11
Endocrinology and Nutrition Service, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
12
Clinical Nutrition Unit, Complejo Hospitalario de Navarra, Spain.
13
Endocrinology and Nutrition Service, Hospital de Cabueñes. Gijón, Asturias, Spain.
14
Endocrinology and Nutrition Service, Hospital del Mar, Barcelona, Spain.
15
Endocrinology and Nutrition Service, Hospital Universitario Son Espases, Palma de Mallorca, Spain.
16
Endocrinology and Nutrition Service, Fundación Jiménez Díaz, Madrid, Spain.
17
Endocrinology and Nutrition Service, Hospital Universitario Gregorio Marañón, Madrid, Spain.
18
Endocrinology and Nutrition Service, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain.
19
Endocrinology and Nutrition Service, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain.
20
Endocrinology and Nutrition Service, Hospital Universitario Virgen del Rocio, Sevilla, Spain.

Abstract

OBJECTIVE:

The prevalence of carbohydrate metabolism disorders in patients who receive total parenteral nutrition (TPN) is not well known. These disorders can affect the treatment, metabolic control, and prognosis of affected patients. The aims of this study were to determine the prevalence in noncritically ill patients on TPN of diabetes, prediabetes, and stress hyperglycemia; the factors affecting hyperglycemia during TPN; and the insulin therapy provided and the metabolic control achieved.

METHODS:

We undertook a prospective multicenter study involving 19 Spanish hospitals. Noncritically ill patients who were prescribed TPN were included, and data were collected on demographic, clinical, and laboratory variables (glycated hemoglobin, C-reactive protein [CRP], capillary blood glucose) as well as insulin treatment.

RESULTS:

The study included 605 patients. Before initiation of TPN, the prevalence of known diabetes was 17.4%, unknown diabetes 4.3%, stress hyperglycemia 7.1%, and prediabetes 27.8%. During TPN therapy, 50.9% of patients had at least one capillary blood glucose of >180 mg/dL. Predisposing factors were age, levels of CRP and glycated hemoglobin, the presence of diabetes, infectious complications, the number of grams of carbohydrates infused, and the administration of glucose-elevating drugs. Most (71.6%) patients were treated with insulin. The mean capillary blood glucose levels during TPN were: known diabetes (178.6 ± 46.5 mg/dL), unknown diabetes (173.9 ± 51.9), prediabetes (136.0 ± 25.4), stress hyperglycemia (146.0 ± 29.3), and normal (123.2 ± 19.9) (P<.001).

CONCLUSION:

The prevalence of carbohydrate metabolism disorders is very high in noncritically ill patients on TPN. These disorders affect insulin treatment and the degree of metabolic control achieved.

PMID:
25148810
DOI:
10.4158/EP13441.OR
[Indexed for MEDLINE]

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