Ethics roundtable debate: child with severe brain damage and an underlying brain tumour

Hyperglycemia and Clinical Outcome in Aneurysmal Subarachnoid Hemorrhage

Background and Purpose— Hyperglycemia may worsen outcome after aneurysmal subarachnoid hemorrhage. We performed a systematic review to investigate the relation between admission hyperglycemia and outcome after aneurysmal subarachnoid hemorrhage.

Methods— We included cohort studies or clinical trials of patients with aneurysmal subarachnoid hemorrhage admitted within 72 hours that documented admission glucose levels or the rate of hyperglycemia. Outcome had to be assessed prospectively after 3 or more months. The overall mean glucose level was calculated by weighting for the number of patients included in each study. To calculate the effect size, we pooled the ORs and 95% 95% CIs of poor clinical outcome in patients with or without hyperglycemia.

Results— We searched MEDLINE, EMBASE, Science Citation Index, and the bibliographies of relevant studies. We included 17 studies totaling 4095 patients. The mean admission glucose level was 9.3 mmol/L (range, 7.4 to 10.9 mmol/L; 14 studies, 3373 patients) and the median proportion of patients with hyperglycemia was 69% (range, 29 to 100; 16 studies, 3995 patients; cutoff levels of hyperglycemia, 5.7 to 12.0 mmol/L). The pooled OR (8 studies, 2164 patients) for poor outcome associated with hyperglycemia was 3.1 (95% CI, 2.3 to 4.3). Cutoff points for defining hyperglycemia varied across studies (6.4 to 11.1 mmol/L), but this had no clear effect on the observed OR for poor outcome.

Conclusions— After aneurysmal subarachnoid hemorrhage, admission glucose levels are often high and hyperglycemia is associated with an increased risk of poor clinical outcome. A randomized clinical trial is warranted to study the potential benefit of glycemic control after aneurysmal subarachnoid hemorrhage.

Influence of fiber on glycemic index of enteral nutrition

BACKGROUND

Enteral nutrition is indicated in patients with malnutrition due to inadequate peroral intake. A number of these patients have diabetes mellitus or impaired glucose tolerance. The aim of the study was to evaluate the influence of fiber-enriched enteral nutrition on postprandial glycemia and insulinemia.

METHODS

Ten healthy volunteers consumed the following solutions: A. 50 g of glucose, B. enteral formula containing 50 g of saccharides, and C. enteral formula containing 50 g of saccharides enriched with 2.3 g of fiber/100 mL. Postprandial glycemia and insulinemia were measured in time period after administration of specified nutrition. Time courses of glycemia and insulinemia were used for calculation of areas under the curve (AUC). The glycemic (GlyI) and insulinemic (InsI) indices of the nutrition were subsequently derived from AUC. Every measurement was performed 3 times for given type of nutrition.

RESULTS

Results are presented as median and interquartile range. GlyI of enteral nutrition was 85.76 (82.71-87.82), GlyI of enteral nutrition with fiber was 84.61 (80.31-94.39). InsI of enteral nutrition was 114.15 (106.55-137.71); InsI of enteral nutrition with fiber was 104.10 (96.71-127.96). The GlyI and InsI results did not differ significantly. Addition of fiber into enteral nutrition did not influence postprandial glycemia in comparison with common enteral nutrition.

CONCLUSIONS

Added fiber in polymerous enteral nutrition does not influence postprandial glycemia compared with polymerous enteral nutrition without fiber.