Endocrinology and Nutrition

Portfolio of services

In our department we treat diseases such as diabetes, morbid or severe obesity and the alterations derived from benign or malignant pathology of endocrine glands (ex. pituitary, thyroid, parathyroid, adrenal, ovary / testicle). We also diagnose and treat the chronic complications of diabetes, dyslipidaemia and other metabolic disorders. We have the following functional units:

• Diabetes Day Hospital (HDD): We care for outpatient patients who, until now, would have required hospital admission, thus improving patient comfort and also saving money. This is the case, for example, of diabetic patients with acute decompensations. Although the vast majority are patients with diabetes, we also get patients with hydro-electrolytic alterations, adrenal crises, etc. The HDD is open to primary care to facilitate better coordination within the country. Every month we attend about 300 patients, most of whom are poorly controlled diabetic patients with associated comorbidity. We carry out about 25 functional tests, about 140 blood extractions and about 40 treatments (e.g. intravenous treatments with insulin, thyroxine and iron) every month and we also provide telematic / telephone monitoring for patients when we have to monitor certain types of treatments.
   
• Diabetes Technology Unit: This unit is part of the HDD and is where continuous insulin infusion systems are implanted and their follow-up is carried out. Candidate patients are also selected for the placement of sensors for continuous monitoring of glycemia and continuous insulin pumps and the treatment is individualized by performing personalized and precision medicine. In addition, a highly qualified nursing team is available to educate patients in whichever therapeutic approach is decided upon. Lastly, we would like to highlight the Diabetes Complications High Resolution Office, where screening for chronic disease complications is done, and new tools are used for diagnosis and treatment.
   
• Diabetic Foot Unit: This unit is coordinated by the Endocrinology and Nutrition Service and with the participation of Angiology, Vascular and endovascular surgery, Traumatology and Orthopaedic Surgery, Physical Medicine and Rehabilitation, Infectious diseases, Plastic Surgery and Burns Unit and Radiology. At the Diabetic Foot Unit, a multidisciplinary team treats the range of pathologies that affect the feet of patients with diabetes. Diabetic neuropathy and ischemia can lead to ulcers, infections, and tissue lesions that can require amputation. This complication must be prevented and treated early in order to minimize morbidity-mortality and the risk of amputation.
   
• Thyroid Pathology Unit: This unit has monographic offices for both benign and malignant pathology. Likewise, a multidisciplinary team deals with thyroid cancer, in turn being a reference centre. In this sense, it is worth mentioning the permanently updated clinical protocol and certain diagnostic and treatment procedures that keep us at the forefront of managing malignant thyroid pathology.
   
• Pituitary Pathology Unit: This is a multidisciplinary and high-complexity functional unit that responds to the sum of activities of two units, adult and paediatric, both coordinated and integrated within the Vall d'Hebron Campus, in such a way that the continued attention to paediatric and adult patients with pituitary pathology is guaranteed. This unit is coordinated by the Endocrinology department and the Neurosurgery, Neuro-radiology and Pathological anatomy and other departments are also part of the activities. This unit has been recognized as the CSUR Center (National Health System Reference units) as well as the ERN (European Reference Network) and Orphanet.
   
• Obesity unit: The obesity unit deals with the evaluation of patients with morbid obesity, defined as a body mass index ≥40 kg/m² or ≥35 kg/m² if it is associated with a comorbidity directly related to said obesity. In addition to the care activity, in the obesity unit we carry out personalized management (endocrinology and dietetics), based on a complete study of complications related to obesity and body composition. The unit is in charge of coordinating the bariatric surgery program that has been operating in our centre and since 2019 the BioBank for Obesity of the Vall d'Hebron Campus. The obesity unit works closely with the endocrine, bariatric, and metabolic surgery unit of the Department of General Surgery, the sleep unit, the Endoscopies Department, and the Psychiatry Department. Notably, the obesity unit has been recognized as a centre of excellence internationally by the European Association for the Study of Obesity (EASO) since 2013.
   
• Lipids Unit: This unit is part of the Transversal Cardiovascular Risk Program and preferentially caters to dyslipidaemia of genetic origin and has merged with the lipid unit of the internal Medicine Department in order to avoid duplications and to save resources. However, it is coordinated with the Departments of Cardiology and Neurology (neurovascular unit) to guarantee the follow-up of patients with dyslipidaemia who present an acute cardiovascular episode.
   
• Nutritional Support Unit (USN): The USN of the Endocrinology and Nutrition Department is staffed by a multidisciplinary health team composed of doctors (endocrinologists, paediatricians), nurses, dieticians-nutritionists, technical dieticians, nursing auxiliaries and administrative personnel. It is a transversal unit, which supports the General Hospital, the Children’s and Women’s Hospital, and the Traumatology, Rehabilitation and Burns Hospital.

Research

It should be noted that our department contains the research group for diabetes and metabolism at VHIR, coordinated by the head of department and that it has a laboratory space of 150m². It is a group consolidated by the AGAUR (Generalitat de Catalunya), which is part of the e-CORE of "Chronic and prevalent diseases, and aging" and "personalized Medicine, innovative diagnosis, molecular image and Digital Health" of VHIR, and belongs to CIBERDEM (ISCIII).

It should be noted that in the last two evaluations made by the ANEP and the external scientific committee (SAB) of the VHIR it has obtained the qualification of the group of excellence and outstanding, respectively. It is also a very remarkable aspect that our Department of Endocrinology and Nutrition stands at number 16 in the World Ranking of Endocrinology Departments, published by the prestigious Newsweek magazine. In this ranking we occupy the first place in Spain and the 5th in Europe.

Commitments

• Offering patients assistance that is of high quality, friendly, respectful, agile, technically excellent, humane and efficient.
   
• Working in conjunction with nursing staff in order to train a consolidated and involved team that allows us to achieve our goals.
   
• To increase continued training and teaching in general, as well as promoting research for all professionals in our department.
   
• To side with and enhance the processes undertaken by the Hospital and Administration to improve the attention given to our patients.
   
• To advance the practice of personalized medicine and implementing digitization and use of new technologies for monitoring patient's with diabetes mellitus.
   
• To facilitate access for patients in our country to our specialized units and subsequent monitoring. The provision of the services described is governed by the guidelines contained in the health management model of the Department of Health of the Generalitat of Catalonia, the applicable general laws and provisions and the institutional commitment to offer high-quality, efficient and high-level care.