Institutional dietary provision for diabetic patients

Benbow, Susan J.; Hoyte, R; Gill, GV

doi:10.1093/qjmed/94.1.27

Cited by 25 publications

(15 citation statements)

References 30 publications

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“…Malnutrition is seen in several patient groups with diabetes, especially in the elderly (19,20) and those with complications such as renal failure or neurological dysfunctions. In these patients, an impaired nutritional status is associated with increased susceptibility to and recovery from infectious complications, the development of pressure sores (and their failure to heal), and general functional decline (21).…”

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confidence: 99%

Enteral Nutritional Support and Use of Diabetes-Specific Formulas for Patients With Diabetes

et al. 2005

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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...

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Enteral Nutritional Support and Use of Diabetes-Specific Formulas for Patients With Diabetes

et al. 2005

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“…L'apparition d'une incontinence urinaire, d'une polyurie nocturne, d'une déshydratation doivent alerter. De même, l'hyperphagie compensatrice est atté-nuée chez le sujet âgé [5]. Le diagnostic de dénutrition doit donc faire rechercher systématiquement une hyperglycémie.…”

Section: Diabète Et Dénutrition : Deux Facteurs De Risque Intriqués Dunclassified

Diabète et nutrition artificielle : principes de prise en charge

Quilliot¹,

Malgras²,

Paquot³

et al. 2013

Nutrition Clinique et Métabolisme

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At home as in the hospital, the diabetic patients are at high risk of malnutrition. In patients with hyperglycemia in artificial nutrition, the primary objective is to to cover their protein needs and their caloric needs and to optimize accordingly the antidiabetic treatment. Insulin therapy is the treatment of choice. The use of low glycaemic index is probably better, especially for oral supplementation. An equivalent parenteral carbohydrate intake has a hyperglycaemic effect more important than with the oral or enteral way. The management of hyperglycemia in artificial nutrition requires defining glycemic goals, tailored to the patient, to the type and the sequences of artificial nutrition, establishing patterns of insulin therapy and providing accurate adaptation rules. Above the basal requirement, insulin therapy sufficient to meet caloric exposure must be prescribed appropriate in timing with the artificial nutrition. The use of sliding scale as monotherapy is ineffective. This management requires forming the nurse team. The acute phase has passed, the disease stabilized, it is sometimes possible to introduce oral antidiabetic drugs and stop insulin. In this case, we apply the same prescription rules to these drugs as for the patient fed orally.

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“…62 There is also evidence of under-nutrition of many residents with diabetes with half of all subjects (slightly worse for those with diabetes) in one study receiving lower dietary energy intakes than recommended. 63 It should come as no surprise that service provision for diabetes fails to reach this group who are often too immobile to get to a GP surgery or a hospital facility. Diabetes UK has published comprehensive guidelines on the management of older people with diabetes in these environments.…”

Section: Care-home Residentsmentioning

confidence: 99%

Diabetes in later life

Aspray

2005

Rev. Clin. Gerontol.

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Type 2 diabetes is a chronic progressive condition with a prevalence which rises with age. Its origins are believed to be multifactorial, and include genetic effects and environmental interactions, which may start in the uterus (with an association with low birth weight) and early developmental plasticity, resulting in compensatory growth through childhood and a tendency to abnormal glucose tolerance in adult life. The consequences are multi-systemic, with a combination of microvascular and macrovascular disease affecting multiple organs of the body. There is a high level of morbidity and mortality, typically accruing through adult life and into older age.

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Institutional dietary provision for diabetic patients

Cited by 25 publications

References 30 publications

Enteral Nutritional Support and Use of Diabetes-Specific Formulas for Patients With Diabetes

Enteral Nutritional Support and Use of Diabetes-Specific Formulas for Patients With Diabetes

Diabète et nutrition artificielle : principes de prise en charge

Diabetes in later life

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