title: Prevalence of diabetes, prediabetes, and stress hyperglycemia: insulin therapy and metabolic control in patients on total parenteral nutrition (prospective multicenter study).
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).
  
  
  CONCLUSIONS
  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.
authors.lastname: Study Group Of Hyperglycemia In Parenteral Nutrition Nutrition Area Of The Spanish Society Of Endocrinology And Nutrition Seen
authors.affiliation: 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.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Olveira
authors.affiliation: Unidad de Gestión Clínica de Endocrinología y Nutrición, IBIMA, Hospital Regional Universitario de Málaga/Universidad de Málaga, Malaga, Spain.
authors.forename: María J
authors.initials: MJ
authors.lastname: Tapia
authors.affiliation: Endocrinology and Nutrition Service, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
authors.forename: Julia
authors.initials: J
authors.lastname: Ocón
authors.affiliation: Endocrinology and Nutrition Service, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Cabrejas-Gómez
authors.affiliation: Endocrinology and Nutrition Service, Complejo Asistencial Universitario de León, Spain.
authors.forename: María D
authors.initials: MD
authors.lastname: Ballesteros-Pomar
authors.affiliation: Endocrinology and Nutrition Service, Complejo Asistencial Universitario de León, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Vidal-Casariego
authors.affiliation: Endocrinology and Nutrition Service, Complejo Hospitalario de Jaén, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Arraiza-Irigoyen
authors.affiliation: Endocrinology and Nutrition Service, Hospital Son Llàtzer (Palma de Mallorca), Spain.
authors.forename: Josefina
authors.initials: J
authors.lastname: Olivares
authors.affiliation: Endocrinology and Nutrition Service, Hospital General Mancha Centro, Alcázar de San Juan, Ciudad-Real, Spain.
authors.forename: María C
authors.initials: MC
authors.lastname: Conde-García
authors.affiliation: Endocrinology and Nutrition Service, Hospital General Mancha Centro, Alcázar de San Juan, Ciudad-Real, Spain.
authors.forename: Álvaro
authors.initials: Á
authors.lastname: García-Manzanares
authors.affiliation: Endocrinology and Nutrition Service, Complejo Hospitalario Universitario de Albacete, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Botella-Romero
authors.affiliation: Endocrinology and Nutrition Service, Complejo Hospitalario Universitario de Albacete, Spain.
authors.forename: Rosa P
authors.initials: RP
authors.lastname: Quílez-Toboso
authors.affiliation: Endocrinology and Nutrition Service, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Lucio
authors.initials: L
authors.lastname: Cabrerizo
authors.affiliation: Endocrinology and Nutrition Service, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Matía
authors.affiliation: Clinical Nutrition Unit, University Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: Luisa
authors.initials: L
authors.lastname: Chicharro
authors.affiliation: Clinical Nutrition Unit, University Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Burgos
authors.affiliation: Endocrinology and Nutrition Service, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Pujante
authors.affiliation: Endocrinology and Nutrition Service, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Ferrer
authors.affiliation: Clinical Nutrition Unit, Complejo Hospitalario de Navarra, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Zugasti
authors.affiliation: Clinical Nutrition Unit, Complejo Hospitalario de Navarra, Spain.
authors.forename: Estrella
authors.initials: E
authors.lastname: Petrina
authors.affiliation: Endocrinology and Nutrition Service, Hospital de Cabueñes. Gijón, Asturias, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Manjón
authors.affiliation: Endocrinology and Nutrition Service, Hospital de Cabueñes. Gijón, Asturias, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Diéguez
authors.affiliation: Endocrinology and Nutrition Service, Hospital del Mar, Barcelona, Spain.
authors.forename: María J
authors.initials: MJ
authors.lastname: Carrera
authors.affiliation: Endocrinology and Nutrition Service, Hospital del Mar, Barcelona, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Vila-Bundo
authors.affiliation: Endocrinology and Nutrition Service, Hospital Universitario Son Espases, Palma de Mallorca, Spain.
authors.forename: Juan R
authors.initials: JR
authors.lastname: Urgelés
authors.affiliation: Endocrinology and Nutrition Service, Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Aragón-Valera
authors.affiliation: Endocrinology and Nutrition Service, Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Olga
authors.initials: O
authors.lastname: Sánchez-Vilar
authors.affiliation: Endocrinology and Nutrition Service, Hospital Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Irene
authors.initials: I
authors.lastname: Bretón
authors.affiliation: Endocrinology and Nutrition Service, Hospital Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: García-Peris
authors.affiliation: Endocrinology and Nutrition Service, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain.
authors.forename: Araceli
authors.initials: A
authors.lastname: Muñoz-Garach
authors.affiliation: Endocrinology and Nutrition Service, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain.
authors.forename: Efren
authors.initials: E
authors.lastname: Márquez
authors.affiliation: Endocrinology and Nutrition Service, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain.
authors.forename: Dolores
authors.initials: D
authors.lastname: del Olmo
authors.affiliation: Endocrinology and Nutrition Service, Hospital Universitario Virgen del Rocio, Sevilla, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Pereira
authors.affiliation: Endocrinology and Nutrition Service, Hospital Universitario Virgen del Rocio, Sevilla, Spain.
authors.forename: María C
authors.initials: MC
authors.lastname: Tous
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000378:metabolism; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology* / Q000378:metabolism; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010289:Parenteral Nutrition, Total / Q000009:adverse effects*; D011236:Prediabetic State / Q000453:epidemiology* / Q000378:metabolism; D015995:Prevalence; D011446:Prospective Studies
chemical_list: D001786:Blood Glucose; D007328:Insulin