Disease-related malnutrition (DRM) can affect different population groups, with hospitalized patients being one of the most affected ones.1 Poor nutritional status favors comorbidities, increases the risk of complications or even mortality in hospitalized subjects.

Nutritional screening tools allow us to identify these patients and assess those who require nutritional treatment,2 which is indicated in patients with malnutrition or who are unable to meet their oral requirements for a long period of time. Enteral nutrition (EN) is the nutrition of choice when the functionality of the GI tract is maintained. It is a safe and effective technique, with complication rates from 16% up to 70% depending on the definition used and the population studied.3

Hospitalized patients may have elevated blood glucose levels without a previous history of diabetes mellitus (DM). This is known as stress hyperglycemia (SH). Prevalence ranges from 4% up to 12% and is associated with increased morbidity and mortality rates.4, 5 Some treatments, such as EN, can lead to hyperglycemia. This alteration has been more studied in patients on parenteral nutrition, however, there are few studies in the case EN. Although the prevalence of hyperglycemia in enteral nutrition (HyperEN) is unknown, it is through to affect between 30% and 47% of the patients and in half of the cases there is no previous diagnosis of diabetes (DM).6 Hyperglycemia in EN is associated with more complications and with the length of stay.7

Clinical practice guidelines and expert consensus recommend monitoring of blood glucose levels and set targets of pre-prandial blood glucose levels <140 mg/dL and at any other time <180 mg/dL for hospitalized patients, both targets in and out of the critical care unit.8 These targets can be changed based on the patient's clinical situation, associated comorbidities and age to achieve acceptable control and reduce the risk of complications, such as hypoglycemia.9

Insulin is the most effective treatment to achieve these goals. A small number of studies have assessed the safety and effectiveness of different insulin administration regimens in these patients.10, 11 Subcutaneous regimens are primarily used in patients on EN. However, the use of insulins has many risks such as increased hypoglycemia.12 On the other hand, the knowledge of the factors that may favour the development of hyperglycemia in EN will allow early intervention or prevention of hyperglycemia.

Specific nutrition formulas adapted for diabetes have been developed to improve glycemic control and reduce insulin requirements. These are preparations with a lower carbohydrate amount, a high amount of fermentable fibre and an increased percentage of predominantly monounsaturated fats that do not worsen the lipid profile. The use of these formulas is often limited to patients with knowing diabetes mellitus or SH.13 Nevertheless, some patients could have a high risk of hyperglycemia, which the use of these formulas could prevent. For this reason, it is important to know the risk factors to developing hyperglycemia in patients on EN.

There are not many studies evaluating risk factors of hyperglycemia in patients on EN, although it is a very common complication in patients on EN that can affect both diabetic and non-diabetic patients. The aim of this study was to analyze which factors may be associated with hyperglycemia in EN in non-diabetic patients with low levels of stress and an indication for EN.