Endocrinology and Nutrition Service

Madrid, Spain

Endocrinology and Nutrition Service

Madrid, Spain
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Olveira G.,University of Malaga | Olveira G.,Institute Salud Carlos III | Tapia M.J.,University of Malaga | Ocon J.,Universitario Lozano Blesa | And 30 more authors.
Diabetes Care | Year: 2013

OBJECTIVE-Hyperglycemia may increase mortality in patients who receive total parenteral nutrition (TPN). However, this has not been well studied in noncritically ill patients (i.e., patients in the nonintensive care unit setting). The aim of this study was to determine whether mean blood glucose level during TPN infusion is associated with increased mortality in noncritically ill hospitalized patients. RESEARCH DESIGN AND METHODS-This prospective multicenter study involved 19 Spanish hospitals. Noncritically ill patients who were prescribed TPN were included prospectively, and data were collected on demographic, clinical, and laboratory variables as well as on in-hospital mortality. RESULTS-The study included 605 patients (mean age 63.2±15.7 years). The daily mean TPN values were 1.630±323 kcal, 3.2±0.7 g carbohydrates/kg, 1.26±0.3 g amino acids/kg, and 0.9±0.2 g lipids/kg. Multiple logistic regression analysis showed that the patients who had mean blood glucose levels >180 mg/dL during the TPN infusion had a risk of mortality that was 5.6 times greater than those withmean blood glucose levels <140mg/dL (95%CI 1.47-21.4 mg/dL) after adjusting for age, sex, nutritional state, presence of diabetes or hyperglycemia before starting TPN, diagnosis, prior comorbidity, carbohydrates infused, use of steroid therapy, SD of blood glucose level, insulin units supplied, infectious complications, albumin, C-reactive protein, and HbA1c levels. CONCLUSIONS-Hyperglycemia (mean blood glucose level >180 mg/dL) in noncritically ill patients who receive TPN is associated with a higher risk of in-hospital mortality. © 2013 by the American Diabetes Association.


Olveira G.,University of Malaga | Olveira G.,CIBER ISCIII | Tapia M.J.,University of Malaga | Ocon J.,Hospital Clinico Universitario Lozano Blesa | And 30 more authors.
Journal of the Academy of Nutrition and Dietetics | Year: 2013

Malnutrition in hospitalized patients is associated with an increased risk of death and complications. The purpose of this study was to determine which nutrition-related risk index predicts mortality better in patients receiving total parenteral nutrition. This prospective, multicenter study involved noncritically ill patients who were prescribed total parenteral nutrition. Data were collected on Subjective Global Assessment (SGA), Nutritional Risk Index, Geriatric Nutritional Risk Index, body mass index, albumin and prealbumin, as well as in-hospital mortality, length of stay, and infectious complications. Of the 605 patients included in the study, 18.8% developed infectious complications and 9.6% died in the hospital. SGA, albumin, Nutritional Risk Index and Geriatric Nutritional Risk Index were associated with longer hospital stay. Prealbumin levels were associated with infectious complications. Multiple logistic regression analysis showed (after adjustment for age, sex, C-reactive protein levels, mean blood glucose levels, use of corticoids, prior comorbidity, carbohydrates infused, diagnosis, and infectious complications) that the SGA, Geriatric Nutritional Risk Index, body mass index, albumin, and prealbumin were associated with an increased risk for in-hospital mortality. SGA was the tool that best predicted mortality and adequately discriminated the values of the other nutrition-related risk indexes studied. The SGA is a clinically effective and simple tool for nutrition assessment in noncritically ill patients receiving total parenteral nutrition and detects the risk of inpatient mortality better than others. © 2013 Academy of Nutrition and Dietetics.


Olveira G.,University of Malaga | Olveira G.,CIBER ISCIII | Tapia M.J.,University of Malaga | Ocon J.,Hospital Clinico Universitario Lozano Blesa | And 31 more authors.
Endocrine Practice | Year: 2015

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. Copyright © 2015 AACE.


Olveira G.,University of Malaga | Olveira G.,CIBER ISCIII | Tapia M.J.,University of Malaga | Ocon J.,Hospital Clinico Universitario Lozano Blesa | And 31 more authors.
Nutrition | Year: 2015

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. © 2015 Elsevier Inc.


Tapia M.J.,University of Malaga | Cabrejas-Gomez C.,Hospital Clinico Universitario Lozano Blesa | Ballesteros-Pomar M.D.,Complejo Asistencial Universitario Of Leon | Vidal-Casariego A.,Complejo Asistencial Universitario Of Leon | And 30 more authors.
Clinical Nutrition | Year: 2015

Background: Malnutrition in hospitalized patients is associated with an increased risk of death, in both the short and the long term. Aims: The purpose of this study was to determine which nutrition-related risk index predicts long-term mortality better (three years) in patients who receive total parenteral nutrition (TPN). Methods: This prospective, multicenter study involved noncritically ill patients who were prescribed TPN during hospitalization. Data were collected on Subjective Global Assessment (SGA), Nutritional Risk Index (NRI), Geriatric Nutritional Risk Index (GNRI), body mass index, albumin and prealbumin, as well as long-term mortality. Results: Over the 1- and 3-year follow-up periods, 174 and 244 study subjects (28.8% and 40.3%) respectively, died. Based on the Cox proportional hazards survival model, the nutrition-related risk indexes most strongly associated with mortality were SGA and albumin (<2.5 g/dL) (after adjustment for age, gender, C-reactive protein levels, prior comorbidity, mean capillary blood glucose during TPN infusion, diabetes status prior to TPN, diagnosis, and infectious complications during hospitalization). Conclusions: The SGA and very low albumin levels are simple tools that predict the risk of long-term mortality better than other tools in noncritically ill patients who receive TPN during hospitalization. © 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism.


PubMed | Hospital Universitario Virgen del Rocio, Complejo Hospitalario Of Jaen, University of Barcelona, Hospital General Mancha Centro and 15 more.
Type: Journal Article | Journal: Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists | Year: 2015

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.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.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).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.

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