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Nutrition. 2015 Jan;31(1):58-63. doi: 10.1016/j.nut.2014.04.023. Epub 2014 May 10.

Hypoglycemia in noncritically ill patients receiving total parenteral nutrition: a multicenter study. (Study group on the problem of hyperglycemia in parenteral nutrition; Nutrition area of the Spanish Society of Endocrinology and Nutrition).

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, Madrid, Spain. Electronic address: gabrielm.olveira.sspa@juntadeandalucia.es.
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, León, Spain.
5
Endocrinology and Nutrition Service, Complejo hospitalario de Jaén, Jaén, Spain.
6
Endocrinology and Nutrition Service, Hospital Son Llàtzer (Palma de Mallorca), Islas Baleares, 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, 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, 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:

Hypoglycemia is a common problem among hospitalized patients. Treatment of hyperglycemia with insulin is potentially associated with an increased risk for hypoglycemia. The aim of this study was to determine the prevalence and predictors of hypoglycemia (capillary blood glucose <70 mg/dL) in hospitalized patients receiving total parenteral nutrition (TPN).

METHODS:

This prospective multicenter study involved 19 Spanish hospitals. Noncritically ill adults who were prescribed TPN were included, thus enabling us to collect data on capillary blood glucose and insulin dosage.

RESULTS:

The study included 605 patients of whom 6.8% (n = 41) had at least one capillary blood glucose <70 mg/dL and 2.6% (n = 16) had symptomatic hypoglycemia. The total number of hypoglycemic episodes per 100 d of TPN was 0.82. In univariate analysis, hypoglycemia was significantly associated with the presence of diabetes, a lower body mass index (BMI), and treatment with intravenous (IV) insulin. Patients with hypoglycemia also had a significantly longer hospital length of stay, PN duration, higher blood glucose variability, and a higher insulin dose. Multiple logistic regression analysis showed that a lower BMI, high blood glucose variability, and TPN duration were risk factors for hypoglycemia. Use of IV insulin and blood glucose variability were predictors of symptomatic hypoglycemia.

CONCLUSIONS:

The occurrence of hypoglycemia in noncritically ill patients receiving PN is low. A lower BMI and a greater blood glucose variability and TPN duration are factors associated with the risk for hypoglycemia. IV insulin and glucose variability were predictors of symptomatic hypoglycemia.

KEYWORDS:

Blood glucose variability; Hypoglycemia; Insulin; Multicenter study; Noncritically ill patients; Parenteral nutrition; Spain

PMID:
25441588
DOI:
10.1016/j.nut.2014.04.023
[Indexed for MEDLINE]

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