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OBJECTIVE -The aim of this systematic review was to determine the benefits of nutritional support in patients with type 1 or type 2 diabetes.RESEARCH DESIGN AND METHODS -Studies utilizing an enteral nutritional support intervention (oral supplements or tube feeding) were identified using electronic databases and bibliography searches. Comparisons of interest were nutritional support versus routine care and standard versus diabetes-specific formulas (containing high proportions of monounsaturated fatty acids, fructose, and fiber). Outcomes of interest were measures of glycemia and lipid status, medication requirements, nutritional status, quality of life, complications, and mortality. Meta-analyses were performed where possible.RESULTS -A total of 23 studies (comprising 784 patients) of oral supplements (16 studies) and tube feeding (7 studies) were included in the review, and the majority compared diabetesspecific with standard formulas. Compared with standard formulas, diabetes-specific formulas significantly reduced postprandial rise in blood glucose (by 1.03 mmol/l [95% CI 0.58 -1.47]; six randomized controlled trials [RCTs]), peak blood glucose concentration (by 1.59 mmol/l [86 -2.32]; two RCTs), and glucose area under curve (by 7.96 mmol ⅐ l Ϫ1 ⅐ min Ϫ1 [2.25-13.66]; four RCTs, i.e., by 35%) with no significant effect on HDL, total cholesterol, or triglyceride concentrations. In addition, individual studies reported a reduced requirement for insulin (26 -71% lower) and fewer complications with diabetes-specific compared with standard nutritional formulas.CONCLUSIONS -This systematic review shows that short-and long-term use of diabetesspecific formulas as oral supplements and tube feeds are associated with improved glycemic control compared with standard formulas. If such nutritional support is given long term, this may have implications for reducing chronic complications of diabetes, such as cardiovascular events. Diabetes Care 28:2267-2279, 2005T he impact of better glycemic control on long-term clinical outcome is well recognized in both type 1 (1) and type 2 (2) diabetes, where hyperglycemia may result in life-threatening complications and numerous comorbidities. In addition, many conditions, including accidental injury, stroke, and critical illness, show a worse outcome in the presence of hyperglycemia (3).In the U.K., the costs associated with major hyperglycemic complications range from £872 (€1,256 or $1,607 for blindness in one eye) to £8,459 (€12,178 or $15,591 for amputation) per patient (4), and the U.S. has reported annual diabetes health care costs of $11,157 (€8,710) per patient (5). This large economic burden is unsurprising given that patients with diabetes are known to be admitted to the hospital more often than other patient groups, accounting for up to 25% of intensive care admissions (3,6). Many of these hospitalized patients will require nutritional support. In addition, an increasing number of patients receive long-term home enteral tube feeding (ETF), including those with diabetes (7...

SUMMARY BackgroundEnteral nutrition can be associated with gastrointestinal side effects and fibre supplementation has been proposed as a means to normalize bowel function.

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The European Pressure Ulcer Advisory Panel (EPUAP) has developed a new practice guideline covering the role of nutrition in pressure ulcer prevention and treatment. This guideline highlights that until now there has been no strong scientific evidence of a direct relationship between poor nutrition and pressure ulceration. Nevertheless, mal nutrition is considered to play a role in pressure ulcer development and healing.

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Dear Editor,With great interest we read the recent publication in the Journal of Parenteral and Enteral Nutrition on the new guidelines for adult critically ill patients. 1 The 2 chapters referring to the use of fibers in critically ill patients caught our attention. To ensure a more complete overview on the effects of fiber in critically ill patients, we would like to raise awareness of our recent systematic review and meta-analysis on the effects of fiber-containing formulas. 2 This is a thorough overview on the role of fiber in enteral nutrition, including patients in the intensive care unit (for which 6 studies and 8 study sets were included in a meta-analysis and meta-regression). The analysis of all studies, including those on intensive care patients, documented good tolerance of fiber-containing formulas, reduction of diarrhea, and a general moderating effect of fiber. The use of single fiber sources seemed less beneficial than fiber mixtures, which were recommended for use in enteral nutrition. Yours sincerely,

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