Evidence-based recommendations and expert consensus on enteral nutrition in the adult patient with diabetes mellitus or hyperglycemia

Sanz-París, A.; Hernández, Julia Álvarez; Ballesteros-Pomar, María D.; Botella-Romero, Francisco; León‐Sanz, Miguel; Martín-Palmero, Ángela; Olmos, Miguel; Olveira, Gabriel

doi:10.1016/j.nut.2017.02.014

Cited by 40 publications

(44 citation statements)

References 79 publications

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“…Recientemente, el grupo de expertos de la ESPEN y diferentes autores comienzan a recoger estos resultados y a recomendar el uso de fórmulas específicas para el control glucémico en el paciente crítico (16,(31)(32)(33), al tiempo que resaltan los posibles beneficios clínicos de la reducción de la variabilidad glucémica y de las complicaciones infecciosas. Es probable que este sea uno de los caminos a desarrollar en los próximos años en la investigación clínica del tratamiento nutrometabólico en la hiperglucemia del paciente crítico.…”

Section: Tratamiento Nutro-metabólico En La Disglicemia Del Paciente unclassified

Octava Lección Jesús Culebras Medicina Intensiva, nutrición e hiperglucemia: una relación muy estrecha

Mesejo

2017

Nutr Hosp

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Section: Tratamiento Nutro-metabólico En La Disglicemia Del Paciente unclassified

Octava Lección Jesús Culebras Medicina Intensiva, nutrición e hiperglucemia: una relación muy estrecha

Mesejo

2017

Nutr Hosp

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“…In patients with diabetes who are on enteral nutrition, the enteral feeds provided can be in the form of either Standard Formulas (SF) or Diabetes Specific Formulas (DSF). Enteral feeding formulas have a tendency to promote hyperglycaemia and insulinemic responses in patients with diabetes and in healthy subjects [16,17]. In addition, the effect of enteral nutrition on blood glucose parameters may be due to the fact that continuous enteral feeding is a source of continuous supply of glucose, providing 10–20 g of carbohydrates per hour, which is not the same during normal eating [15].…”

Section: Introductionmentioning

confidence: 99%

“…DSFs usually contain carbohydrates with low GI such as fructose and large amounts of monounsaturated fatty acids in varying amounts, which have effect on glycaemic control [17,18,19,20]. On the other hand, SFs are often high in carbohydrate and contain only low to moderate levels of lipids and do not have dietetic fibre [17].…”

Section: Introductionmentioning

confidence: 99%

“…Previous reviews on the use of enteral nutrition in patients with diabetes [16,17,21,22,23] either lacked consensus in the recommendations, were based only on glycaemic control or did not involve meta-analysis. In addition, concerns remain with the use of DSF in terms of the safety and tolerance of relatively high levels of fat and fructose with respect to lipid metabolism and lactic acidosis, despite its advantage in improving blood glucose compared with SFs [16,19].…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Diabetes-Specific Enteral Nutrition Formula on Cardiometabolic Parameters in Patients with Type 2 Diabetes: A Systematic Review and Meta–Analysis of Randomised Controlled Trials

et al. 2019

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Background: The prevalence of diabetes is on the increase in the UK and worldwide, partly due to unhealthy lifestyles, including poor dietary regimes. Patients with diabetes and other co-morbidities such as stroke, which may affect swallowing ability and lead to malnutrition, could benefit from enteral nutrition, including the standard formula (SF) and diabetes-specific formulas (DSF). However, enteral nutrition presents its challenges due to its effect on glycaemic control and lipid profile. Aim: The aim of this review was to evaluate the effectiveness of diabetes-specific enteral nutrition formula versus SF in managing cardiometabolic parameters in patients with type 2 diabetes. Method: This review was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses. Three databases (Pubmed, EMBASE, PSYCInfo) and Google scholar were searched for relevant articles from inception to 2 January 2019 based on Population, Intervention, Comparator, Outcomes and Study designs (PICOS) framework. Key words, Medical Subject Heading (MeSH) terms, and Boolean operators (AND/OR) formed part of the search strategy. Articles were evaluated for quality and risks of bias. Results: Fourteen articles were included in the systematic review and five articles were selected for the meta-analysis. Based on the findings of the review and meta-analysis, two distinct areas were evident: the effect of DSF on blood glucose parameters and the effect of DSF on lipid profile. All fourteen studies included in the systematic review showed that DSF was effective in lowering blood glucose parameters in patients with type 2 diabetes compared with SF. The results of the meta-analysis confirmed the findings of the systematic review with respect to the fasting blood glucose, which was significantly lower (p = 0.01) in the DSF group compared to SF, with a mean difference of −1.15 (95% CI −2.07, −0.23) and glycated haemoglobin, which was significantly lower (p = 0.005) in the DSF group compared to the SF group following meta-analysis and sensitivity analysis. However, in relation to the sensitivity analysis for the fasting blood glucose, differences were not significant between the two groups when some of the studies were removed. Based on the systematic review, the outcomes of the studies selected to evaluate the effect of DSF on lipid profile were variable. Following the meta-analysis, no significant differences (p > 0.05) were found between the DSF and SF groups with respect to total cholesterol, LDL cholesterol and triglyceride. The level of the HDL cholesterol was significantly higher (p = 0.04) in the DSF group compared to the SF group after the intervention, with a mean difference of 0.09 (95% CI, 0.00, 0.18), although this was not consistent based on the sensitivity analysis. The presence of low glycaemic index (GI) carbohydrate, the lower amount of carbohydrate and the higher protein, the presence of mono-unsaturated fatty acids and the different amounts and types of fibre in the DSF compared with SF may be responsible for the observed differences in cardiometabolic parameters in both groups. Conclusion: The results provide evidence to suggest that DSF is effective in controlling fasting blood glucose and glycated haemoglobin and in increasing HDL cholesterol, but has no significant effect on other lipid parameters. However, our confidence in these findings would be increased by additional data from further studies.

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“…Every 48−72 h we should assess compliance with the therapeutic objectives, and if these are not reached despite oral supplementing, the data from the EFFORT trial and the usual recommendations of the clinical guides referring to patients of this kind with multiple diseases 10 underline the need for early enteral nutrition, either complementary to oral feeding or complete, and preferably using a hyperproteic-hypercaloric formula adjusted to the estimated requirements. The frequent presence of diabetes or hyperglycemia in these patients (either due to metabolic stress or in relation to corticosteroid therapy) may make it reasonable to use diabetes-specific hyperproteic formulas, which have shown clinical benefits 11 . The blood glucose levels should be monitored, with a target of 100−140 mg/dl.…”

mentioning

confidence: 99%

Clinical Nutrition in times of COVID-19

Pomar¹,

Lesmes

2020

Endocrinología, Diabetes y Nutrición (English ed.)

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Evidence-based recommendations and expert consensus on enteral nutrition in the adult patient with diabetes mellitus or hyperglycemia

Cited by 40 publications

References 79 publications

Octava Lección Jesús Culebras Medicina Intensiva, nutrición e hiperglucemia: una relación muy estrecha

Octava Lección Jesús Culebras Medicina Intensiva, nutrición e hiperglucemia: una relación muy estrecha

The Effect of Diabetes-Specific Enteral Nutrition Formula on Cardiometabolic Parameters in Patients with Type 2 Diabetes: A Systematic Review and Meta–Analysis of Randomised Controlled Trials

Clinical Nutrition in times of COVID-19

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