Prevalence of diabetes, prediabetes, and stress hyperglycemia: insulin therapy and metabolic control in patients on total parenteral nutrition (prospective multicenter study).
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Study Group Of Hyperglycemia In Parenteral Nutrition Nutrition Area Of The Spanish Society Of Endocrinology And Nutrition Seen, Olveira Gabriel, Tapia María J, Ocón Julia, Cabrejas-Gómez Carmen, Ballesteros-Pomar María D, Vidal-Casariego Alfonso, Arraiza-Irigoyen Carmen, Olivares Josefina, Conde-García María C, García-Manzanares Álvaro, Botella-Romero Francisco, Quílez-Toboso Rosa P, Cabrerizo Lucio, Matía Pilar, Chicharro Luisa, Burgos Rosa, Pujante Pedro, Ferrer Mercedes, Zugasti Ana, Petrina Estrella, Manjón Laura, Diéguez Marta, Carrera María J, Vila-Bundo Anna, Urgelés Juan R, Aragón-Valera Carmen, Sánchez-Vilar Olga, Bretón Irene, García-Peris Pilar, Muñoz-Garach Araceli, Márquez Efren, del Olmo Dolores, Pereira José Luis, Tous María C
Аннотация
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.