title: 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).
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.
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, Madrid, Spain. Electronic address: gabrielm.olveira.sspa@juntadeandalucia.es.
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 José
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, León, Spain.
authors.forename: María D
authors.initials: MD
authors.lastname: Ballesteros-Pomar
authors.affiliation: Endocrinology and Nutrition Service, Complejo Asistencial Universitario de León, León, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Vidal-Casariego
authors.affiliation: Endocrinology and Nutrition Service, Complejo hospitalario de Jaén, Jaén, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Arraiza-Irigoyen
authors.affiliation: Endocrinology and Nutrition Service, Hospital Son Llàtzer (Palma de Mallorca), Islas Baleares, 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: Maria Carmen
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, Albacete, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Botella-Romero
authors.affiliation: Endocrinology and Nutrition Service, Complejo Hospitalario Universitario de Albacete, 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: Pilar
authors.initials: P
authors.lastname: Matía
authors.affiliation: Endocrinology and Nutrition Service, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Rubio
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, Navarra, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Zugasti
authors.affiliation: Clinical Nutrition Unit, Complejo Hospitalario de Navarra, 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: Ma José
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 Ramón
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: D061605:Administration, Intravenous; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D016638:Critical Illness; D004305:Dose-Response Relationship, Drug; D005260:Female; D006760:Hospitalization; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology* / Q000209:etiology; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D010289:Parenteral Nutrition, Total / Q000009:adverse effects*; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology
chemical_list: D001786:Blood Glucose; D007328:Insulin
keywords: Blood glucose variability; Hypoglycemia; Insulin; Multicenter study; Noncritically ill patients; Parenteral nutrition; Spain