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Chinese Guidelines for Medical Nutrition Therapy for Patients with Diabetes (2022 Edition). Asia Pac J Clin Nutr 2024; 33:118-152. [PMID: 38794974 PMCID: PMC11170023 DOI: 10.6133/apjcn.202406_33(2).0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 05/05/2024] [Indexed: 05/27/2024]
Abstract
Medical nutrition therapy (MNT) is the foundation of the comprehensive treatment of patients with diabetes. In 2010, the Chinese Clinical Nutritionist Center of the Chinese Medical Doctor Association developed the first Chinese guideline on MNT for patients with diabetes, and it was updated in 2015. Since then, new evidence has emerged in the field of MNT and metabolic therapy in patients with diabetes. The Nutrition and Metabolic Management Branch of the China International Exchange and Promotive Association for Medical and Health Care organized a team of experts from related institutions, including the Clinical Nutrition Branch of the Chinese Nutrition Society, Chinese Diabetes Society, Chinese Society for Parenteral and Enteral Nutri-tion, and Chinese Clinical Nutritionist Center of the Chinese Medical Doctor Association. Their task was to develop the Chinese Guidelines of Medical Nutrition Therapy in Diabetes (2022 Edition) in accordance with the requirements of the Guidelines for the Formulation/Revision of Clinical Guidelines in China (2022 Edition) by combining the questions raised and evidence gathered in clinical practices in China, to guide and standardize the clinical MNT.
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Wu J, Wu J, Zhou Y, Lu X, Zhao W, Xu F. Nomogram for Predicting Hypoglycemia in Type 2 Diabetes Mellitus Patients Treated with Insulin Pump During Enteral Nutrition. Diabetes Metab Syndr Obes 2024; 17:2147-2154. [PMID: 38827166 PMCID: PMC11141570 DOI: 10.2147/dmso.s436390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 05/03/2024] [Indexed: 06/04/2024] Open
Abstract
Purpose To develop a prediction model for hypoglycemia in type 2 diabetes mellitus (T2DM) patients treated with an insulin pump during enteral nutrition. Methods This retrospective study included T2DM patients treated with an insulin pump during enteral nutrition at the First Affiliated Hospital of Jinan University, Guangzhou Red Cross Hospital, Foshan First People's Hospital, and Guangdong Provincial Hospital of Traditional Chinese Medicine between January 2016 and December 2023. The patients were randomized 3:1 to the training and validation sets. The risk factors for hypoglycemia were analyzed. A prediction model was developed. Results This study included 122 patients, and 57 patients had at least one hypoglycemic event during their hospitalization (46.72%). The multivariable logistic regression analysis showed that the time to reach the glycemic targets (odds ratio (OR)=1.408, 95% confidence interval (CI)=1.084-1.825, P=0.006), average glycemia (OR=0.387, 95% CI=0.233-0.643, P=0.010), coronary heart disease (OR=0.089, 95% CI=0.016-0.497, P<0.001), and the administration of hormone therapy (OR=6.807, 95% CI=1.128-41.081, P=0.037) were independently associated with hypoglycemia. A nomogram was built. The receiver operating characteristics analysis showed that the area under the curve of the model was 0.872 (95% CI=0.0.803-0.940) for the training set and 0.839 (95% CI=0.688-0.991) in the validation set. Conclusion A nomogram was successfully built to predict hypoglycemia in T2DM patients treated with an insulin pump during enteral nutrition, based on the time to reach the glycemic targets, average glycemia, coronary heart disease, and the administration of hormone therapy.
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Affiliation(s)
- Jufei Wu
- Department of Neurosurgery, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
| | - Jishi Wu
- Department of General Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
| | - Yan Zhou
- Department of Interventional Radiology & Vascular Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
| | - Xiaohua Lu
- Department of Endocrinology, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
| | - Wane Zhao
- Department of Endocrinology, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
| | - Fengmei Xu
- Department of Neurosurgery, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
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Mongkolsucharitkul P, Pinsawas B, Surawit A, Pongkunakorn T, Manosan T, Ophakas S, Suta S, Pumeiam S, Mayurasakorn K. Diabetes-Specific Complete Smoothie Formulas Improve Postprandial Glycemic Response in Obese Type 2 Diabetic Individuals: A Randomized Crossover Trial. Nutrients 2024; 16:395. [PMID: 38337679 PMCID: PMC10857113 DOI: 10.3390/nu16030395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 01/25/2024] [Accepted: 01/27/2024] [Indexed: 02/12/2024] Open
Abstract
This study aimed to compare newly developed diabetes-specific complete smoothie formulas with a standard diabetes-specific nutritional formula (DSNF) regarding their effects on glucose homeostasis, insulin levels, and lipid metabolism in obese type 2 diabetes (T2DM) patients. We conducted a randomized, double-blind, crossover study with 41 obese T2DM participants to compare two developed diabetes-specific complete smoothie formulas, a soy-based regular smoothie (SM) and a smoothie with modified carbohydrate content (SMMC), with the standard DSNF, Glucerna. Glycemic and insulin responses were assessed after the participants randomly consumed 300 kilocalories of each formulation on three separate days with a 7-day gap between. Postprandial effects on glycemic control, insulin levels, and lipid metabolism were measured. SMMC resulted in a significantly lower glucose area under the curve (AUC0-240) compared to Glucerna and SM (p < 0.05 for both). Insulin AUC0-240 after SMMC was significantly lower than that after SM and Glucerna (p < 0.05). During the diets, the suppression of NEFA was more augmented on SM, resulting in a less total AUC0-240 of NEFA compared to the SMMC diet (p < 0.05). C-peptide AUC0-240 after SMMC was significantly lower than that after Glucerna (p < 0.001). Conversely, glucagon AUC0-240 after SMMC was significantly higher than that after SM and Glucerna (p < 0.05). These results highlight SMMC as the better insulin-sensitive formula, potentially achieved through increased insulin secretion or a direct reduction in glucose absorption. The unique composition of carbohydrates, amino acids, and fats from natural ingredients in the smoothies may contribute to these positive effects, making them promising functional foods for managing diabetes and obesity.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Korapat Mayurasakorn
- Siriraj Population Health and Nutrition Research Group, Department of Research Group and Research Network, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (P.M.); (B.P.); (A.S.); (T.P.); (T.M.); (S.O.); (S.S.); (S.P.)
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Rebollo-Pérez MI, Florencio Ojeda L, García-Luna PP, Irles Rocamora JA, Olveira G, Lacalle Remigio JR, Arraiza Irigoyen C, Calañas Continente A, Campos Martín C, Fernández Soto ML, García Almeida JM, López ML, Losada Morell C, Luengo Pérez LM, Muñoz de Escalona Martínez T, Pereira-Cunill JL, Vílchez-López FJ, Rabat-Restrepo JM. Standards for the Use of Enteral Nutrition in Patients with Diabetes or Stress Hyperglycaemia: Expert Consensus. Nutrients 2023; 15:4976. [PMID: 38068834 PMCID: PMC10707756 DOI: 10.3390/nu15234976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
(1) Background: Hyperglycaemia that occurs during enteral nutrition (EN) should be prevented and treated appropriately since it can have important consequences for morbidity and mortality. However, there are few quality studies in the literature regarding the management of EN in this situation. The objective of this project was to attempt to respond, through a panel of experts, to those clinical problems regarding EN in patients with diabetes or stress hyperglycaemia (hereinafter referred to only as hyperglycaemia) for which we do not have conclusive scientific evidence; (2) Methods: The RAND/UCLA Appropriateness Method, a modified Delphi panel method, was applied. A panel of experts made up of 10 clinical nutrition specialists was formed, and they scored on the appropriateness of EN in hyperglycaemia, doing so in two rounds. A total of 2992 clinical scenarios were examined, which were stratified into five chapters: type of formula used, method of administration, infusion site, treatment of diabetes, and gastrointestinal complications. (3) Results: consensus was detected in 36.4% of the clinical scenarios presented, of which 23.7% were deemed appropriate scenarios, while 12.7% were deemed inappropriate. The remaining 63.6% of the scenarios were classified as uncertain; (4) Conclusions: The recommendations extracted will be useful for improving the clinical management of these patients. However, there are still many uncertain scenarios reflecting that the criteria for the management of EN in hyperglycaemia are not completely standardised. More studies are required to provide quality recommendations in this area.
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Affiliation(s)
- María I. Rebollo-Pérez
- Endocrinology and Nutrition Clinical Management Unit, University Hospital Juan Ramón Jiménez, 21005 Huelva, Spain; (M.I.R.-P.); (L.F.O.); (M.L.L.)
| | - Luna Florencio Ojeda
- Endocrinology and Nutrition Clinical Management Unit, University Hospital Juan Ramón Jiménez, 21005 Huelva, Spain; (M.I.R.-P.); (L.F.O.); (M.L.L.)
| | - Pedro P. García-Luna
- Regional Andalusian Health Service, Service of Endocrinology and Nutrition, University Hospitals Virgen del Rocío, 41013 Seville, Spain; (P.P.G.-L.); (J.L.P.-C.)
- Faculty of Medicine, University of Seville, 41009 Seville, Spain; (J.A.I.R.); (J.M.R.-R.)
| | - José A. Irles Rocamora
- Faculty of Medicine, University of Seville, 41009 Seville, Spain; (J.A.I.R.); (J.M.R.-R.)
- Endocrinology and Nutrition Clinical Management Unit, University Hospital Valme, 41014 Seville, Spain
| | - Gabriel Olveira
- Biomedical Research Institute of Málaga (IBIMA), 29010 Málaga, Spain;
- Endocrinology and Nutrition Clinical Management Unit, Regional University Hospital of Málaga/University of Málaga, 29010 Málaga, Spain
- Biomedical Network Research Centre for Diabetes and Associated Metabolic Diseases (CIBERDEM) (CB07/08/0019), Health institute Carlos III, 28029 Madrid, Spain
- Medicine and Dermatology Department, Faculty of Medicine, University of Málaga, 29010 Málaga, Spain
| | | | | | - Alfonso Calañas Continente
- Endocrinology and Nutrition Clinical Management Unit, University Hospital Reina Sofia, 14004 Córdoba, Spain;
| | - Cristina Campos Martín
- Endocrinology and Nutrition Clinical Management Unit, University Hospital Virgen Macarena, 41009 Seville, Spain
| | - María Luisa Fernández Soto
- Endocrinology and Nutrition Clinical Management Unit, University Hospital San Cecilio, 18012 Granada, Spain;
- Biosanitary Institute of Granada, Medicine Department, Faculty of Medicine of Granada, University of Granada, 18010 Granada, Spain
| | - José Manuel García Almeida
- Biomedical Research Institute of Málaga (IBIMA), 29010 Málaga, Spain;
- Endocrinology and Nutrition Clinical Management Unit, University Hospital Virgen de la Victoria, 29010 Málaga, Spain
| | - María Laínez López
- Endocrinology and Nutrition Clinical Management Unit, University Hospital Juan Ramón Jiménez, 21005 Huelva, Spain; (M.I.R.-P.); (L.F.O.); (M.L.L.)
| | - Concepción Losada Morell
- Endocrinology and Nutrition Clinical Management Unit, Internal Medicine Clinical Management Unit, Hospital Infanta Margarita, 14940 Cabra, Córdoba, Spain;
| | | | | | - José L. Pereira-Cunill
- Regional Andalusian Health Service, Service of Endocrinology and Nutrition, University Hospitals Virgen del Rocío, 41013 Seville, Spain; (P.P.G.-L.); (J.L.P.-C.)
- Faculty of Medicine, University of Seville, 41009 Seville, Spain; (J.A.I.R.); (J.M.R.-R.)
| | - Francisco J. Vílchez-López
- Endocrinology and Nutrition Clinical Management Unit, Biomedical Research and Innovation Institute of Cádiz, University Hospital Puerta del Mar, 11009 Cádiz, Spain;
| | - Juana M. Rabat-Restrepo
- Faculty of Medicine, University of Seville, 41009 Seville, Spain; (J.A.I.R.); (J.M.R.-R.)
- Endocrinology and Nutrition Clinical Management Unit, University Hospital Virgen Macarena, 41009 Seville, Spain
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Tak J, Bok M, Rho H, Park JH, Lim Y, Chon S, Lim H. Effect of diabetes-specific oral nutritional supplements with allulose on weight and glycemic profiles in overweight or obese type 2 diabetic patients. Nutr Res Pract 2023; 17:241-256. [PMID: 37009137 PMCID: PMC10042715 DOI: 10.4162/nrp.2023.17.2.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/30/2022] [Accepted: 09/06/2022] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND/OBJECTIVES Diabetes-specific oral nutritional supplements (ONS) have anti-hyperglycemic effects, while D-allulose exerts anti-diabetic and anti-obesity effects. In this study, we investigated the efficacy and safety of diabetes-specific ONS, including allulose, on glycemic and weight changes in overweight or obese patients with type 2 diabetes mellitus (T2DM). SUBJECTS/METHODS A single-arm, historical-control pilot clinical trial was conducted on 26 overweight or obese patients with T2DM (age range: 30-70 yrs). The participants were administered 2 packs of diabetes-specific ONS, including allulose (200 kcal/200 mL), every morning for 8 weeks. The glycemic profiles, obesity-related parameters, and lipid profiles were assessed to evaluate the efficacy of ONS. RESULTS After 8 weeks, fasting blood glucose (FBG) level significantly decreased from 139.00 ± 29.66 mg/dL to 126.08 ± 32.00 mg/dL (P = 0.007) and glycosylated hemoglobin (HbA1c) improved (7.23 ± 0.82% vs. 7.03 ± 0.69%, P = 0.041). Moreover, the fasting insulin (δ: -1.81 ± 3.61 μU/mL, P = 0.017) and homeostasis model assessment for insulin resistance (HOMA-IR) (δ: -0.87 ± 1.57, P = 0.009) levels decreased at 8 weeks, and body weight significantly decreased from 67.20 ± 8.29 kg to 66.43 ± 8.12 kg (P = 0.008). Body mass index (BMI) also decreased in accordance with this (from 25.59 ± 1.82 kg/m2 to 25.30 ± 1.86 kg/m2, P = 0.009), as did waist circumference (δ: -1.31 ± 2.04 cm, P = 0.003). CONCLUSIONS The consumption of diabetes-specific ONS with allulose in overweight or obese patients with T2DM improved glycemic profiles, such as FBG, HbA1c, and HOMA-IR, and reduced body weight and BMI.
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Affiliation(s)
- Jihye Tak
- Department of Medical Nutrition, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Korea
| | - Minkyung Bok
- Department of Medical Nutrition, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Korea
- Research Institute of Medical Nutrition, Kyung Hee University, Seoul 02447, Korea
| | - Hyunkyung Rho
- Department of Food and Nutrition, Kyung Hee University, Seoul 02447, Korea
| | - Ju Hyun Park
- Department of Medical Nutrition, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Korea
- Research Institute of Medical Nutrition, Kyung Hee University, Seoul 02447, Korea
| | - Yunsook Lim
- Department of Food and Nutrition, Kyung Hee University, Seoul 02447, Korea
| | - Suk Chon
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul 02447, Korea
| | - Hyunjung Lim
- Department of Medical Nutrition, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Korea
- Research Institute of Medical Nutrition, Kyung Hee University, Seoul 02447, Korea
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Mu D, Gong J, Wei Y, Chen M, Yu J, Du L, Hu W. Development of core outcome sets of Food for Special Medical Purposes designed for type 2 diabetes mellitus: a study protocol. Trials 2023; 24:223. [PMID: 36959627 PMCID: PMC10037765 DOI: 10.1186/s13063-023-07214-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/02/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND The Chinese government stipulates all food for special medical purposes (FSMP) designed for specific diseases to be tested in clinical trials before approving it for registration. The process of developing core outcome sets (COSs), the minimum sets of outcomes supposed to be measured and reported, provides an economical and practical option for stakeholders to communicate and cooperate in conducting clinical trials as well as in reporting FSMP outcomes. This study uses type 2 diabetes mellitus (T2DM) as an example to develop COS for clinical trials of FSMP. METHODS The COS for FSMP-T2DM will be divided into 3 phases and developed following COS-STAP and COS-STAD: (1) Generate a list of relevant outcomes identified from a systematic review, in which information sources will mainly include published studies, regulatory documentation, and qualitative interviews of stakeholders. The identified outcomes will be categorized using a conceptual framework and formatted into the first round of the Delphi survey questionnaire items. (2) At least 2 rounds of Delphi surveys will be performed among stakeholders to create the COS for FSMP-T2DM. Patients, clinical dietitians, physicians, COS researchers, journal editors, FSMP manufacturers, and regulatory representatives will be invited to score each outcome from aspects of importance. (3) Hold a face-to-face or online consensus meeting to refine the content of the COS for FSMP-T2DM. Key stakeholders will be invited to attend the meeting to discuss and agree on the final COS. DISCUSSION We have prepared an alternative solution of the Likert scale selection, Delphi survey rounds, scoring group, and consensus definitions in case of an unexpected situation. TRIAL REGISTRATION COMET (1547). Registered on March 23, 2020.
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Affiliation(s)
- Dongyu Mu
- Department of Clinical Nutrition, West China Hospital, Sichuan University, #37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Jie Gong
- Department of Clinical Nutrition, West China Hospital, Sichuan University, #37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Yaoyao Wei
- West China School of Public Health, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Muxi Chen
- West China School of Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Jiajie Yu
- The Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Liang Du
- West China Medical Publishers, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Wen Hu
- Department of Clinical Nutrition, West China Hospital, Sichuan University, #37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan Province, People's Republic of China.
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Polavarapu P, Pachigolla S, Drincic A. Glycemic Management of Hospitalized Patients Receiving Nutrition Support. Diabetes Spectr 2022; 35:427-439. [PMID: 36561651 PMCID: PMC9668719 DOI: 10.2337/dsi22-0010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Enteral nutrition (EN) and parenteral nutrition (PN) increase the risk of hyperglycemia and adverse outcomes, including mortality, in patients with and without diabetes. A blood glucose target range of 140-180 mg/dL is recommended for hospitalized patients receiving artificial nutrition. Using a diabetes-specific EN formula, lowering the dextrose content, and using a hypocaloric PN formula have all been shown to prevent hyperglycemia and associated adverse outcomes. Insulin, given either subcutaneously or as a continuous infusion, is the mainstay of treatment for hyperglycemia. However, no subcutaneous insulin regimen has been shown to be superior to others. This review summarizes the evidence on and provides recommendations for the treatment of EN- and PN-associated hyperglycemia and offers strategies for hypoglycemia prevention. The authors also highlight their institution's protocol for the safe use of insulin in the PN bag. Randomized controlled trials evaluating safety and efficacy of targeted insulin therapy synchronized with different types of EN or PN delivery are needed.
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Affiliation(s)
- Preethi Polavarapu
- Department of Diabetes, Endocrinology and Metabolism, Division of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
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de Luis Román D, Rodas LV, Reyes LM, López Medina JA, Palmero ÁM, Candela CG, Bonmatí EM, Guzmán G, Camprubi-Robles M, Fernández LR. A prospective, observational study of the use of a high-calorie, high-protein tube feeding formula with slow-release carbohydrates and monounsaturated fatty acids in a malnourished population with diabetes. CLINICAL NUTRITION OPEN SCIENCE 2022. [DOI: 10.1016/j.nutos.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Jenssen C, Pietsch C. Stationäre Patienten mit der Nebendiagnose Diabetes mellitus: klinische Relevanz. DIABETOLOGE 2022. [PMCID: PMC9045025 DOI: 10.1007/s11428-022-00897-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In deutschen Krankenhäusern werden jährlich etwa 3 Mio. Patienten mit Diabetes stationär behandelt, davon 93 % nicht wegen, sondern mit dieser Erkrankung. In einzelnen Fachabteilungen liegt bei bis zu 40 % der Patienten die Nebendiagnose Diabetes vor. Sie haben oft eine relevante Komorbidität und im Vergleich zu Krankenhauspatienten ohne Diabetes eine längere stationäre Verweildauer, entwickeln deutlich häufiger Komplikationen und müssen öfter kurzfristig wieder aufgenommen werden. In dieser Übersicht wird die klinische Relevanz der Nebendiagnose Diabetes mellitus für Krankenhauspatienten besprochen.
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Affiliation(s)
- Christian Jenssen
- Klinik für Innere Medizin, Krankenhaus Märkisch-Oderland GmbH, 15344 Strausberg, Deutschland
| | - Cristine Pietsch
- Klinik für Innere Medizin, Krankenhaus Märkisch-Oderland GmbH, 15344 Strausberg, Deutschland
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Jinjing W, Kang C, Xufei L, Xueqiong L, Xinye J, Miao Y, Jinping Z, Zhaohui L, Jingtao D, Yaolong C, Linong J, Yiming M. Chinese clinical practice guidelines for perioperative blood glucose management. Diabetes Metab Res Rev 2021; 37:e3439. [PMID: 33605539 DOI: 10.1002/dmrr.3439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 01/04/2021] [Accepted: 01/11/2021] [Indexed: 12/20/2022]
Abstract
With the increased incidence of diabetes, the number of diabetic patients who require surgical treatment is also increasing. Unfortunately, practices in this area lack standardisation. The purpose of this multidisciplinary, evidence-based guidelines for perioperative blood glucose management is to provide a comprehensive set of recommendations for clinicians treating diabetes with different types of surgery. The intended audience comprises Chinese endocrinologists, surgeons, anaesthetists, clinical pharmacists, nurses and professionals involved in perioperative blood glucose management. The guidelines were formulated as follows. First, a multidisciplinary expert group was established to identify and formulate key research questions on topics of priority according to the Population, Intervention, Comparator and Outcomes (PICO) process. We conducted a meta-analysis of available studies using Review Manager version 5.3, as appropriate. We pooled crude estimates as odds ratios with 95% confidence intervals using a random-effects model, and used the Grading of Recommendations Assessment, Development, and Evaluation methods to assess the quality of the retrieved evidence. Finally, 32 recommendations were gathered that covered 11 fields-management and coordination, endocrinologists' consultation, diabetes diagnosis, surgery timing and anaesthesia method, blood glucose target values and monitoring frequency, hypoglycaemia treatment, oral administration of blood glucose lowering drugs, use of insulin, enteral and parenteral nutritional, postoperative treatment and medication and education and training. Twenty-five systematic reviews and meta-analyses were conducted for these guidelines to address the PICO questions. These guidelines are intended to improve perioperative blood glucose management and help doctors in specifying medical diagnosis and treatment, and will be implemented / disseminated extensively in China.
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Affiliation(s)
- Wang Jinjing
- Department of Endocrinology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
- Department of Endocrinology, Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Chen Kang
- Department of Endocrinology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Luo Xufei
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Li Xueqiong
- Department of Dry Therapy, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jin Xinye
- Department of Endocrinology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
- Department of Nephrology, Hainan Hospital of Chinese PLA General Hospital, the Hainan Academician Team Innovation Center, Hainan, China
| | - Yu Miao
- Department of EndocrinologyKey Laboratory of EndocrinologyNational Health Commission, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zhang Jinping
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China
| | - Lv Zhaohui
- Department of Endocrinology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Dou Jingtao
- Department of Endocrinology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Chen Yaolong
- Institute of Health Data Science, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Ji Linong
- Department of Endocrinology and Metabolism, Peking University people's Hospital, Peking University Diabetes Center, Beijing, China
| | - Mu Yiming
- Department of Endocrinology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
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BAI Q, XU J, ZHU W, HUANG C, NI X, ZHAO H, FENG X, LI L, DU S, FAN R, WANG J. Effects of consumption of a low glycaemic index formula on glycaemic control in patients with type 2 diabetes managed by medical nutrition therapy. FOOD SCIENCE AND TECHNOLOGY 2021. [DOI: 10.1590/fst.51320] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
| | - Jing XU
- Army Medical University, China
| | | | | | | | | | | | - Li LI
- Army Medical University, China
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Eckert I, Kumbier MCC, Silva FM, Franzosi OS, de Almeida JC. Association of specialized enteral nutrition with glycemic control and clinical outcomes in critically ill patients: A meta-analysis of randomized controlled trials. Clin Nutr 2021; 40:3940-3949. [PMID: 34139467 DOI: 10.1016/j.clnu.2021.04.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/06/2021] [Accepted: 04/19/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate the association of glycemic-control formulae (GCF) with measurements of glycemic control and clinical outcomes compared to standard enteral formulae (SF) in critically ill patients. DATA SOURCES MEDLINE, EMBASE, Scopus and the Cochrane Central Register of Controlled Trials were searched from inception up to January, 2021. STUDY SELECTION RCTs that assessed the effects of GCF relative to SF in adult critically ill patients. DATA EXTRACTION Measurements of glycemic control were the primary outcomes. Secondary outcomes included insulin requirements, mechanical ventilation (MV), length of intensive care unit (ICU) stay and mortality. Two authors independently extracted data and assessed risk of bias using the Cochrane's RoB 2 tool and the GRADE approach was used to assess the quality of evidence. DATA SYNTHESIS Ten studies (12 reports, 685 patients) were included. The use of GCFs was associated with lower blood glucose (WMD, -16.06 mg/dL; 95% CI -23.48 to -8.63; I2 = 47%) and lower daily administered insulin (WMD, -7.20 IU; 95% CI -13.92 to -0.48; I2 = 53%). Glycemic variability, measured by the coefficient of variation, was also associated with the use of GCFs (WMD, -6.84%; 95% CI, -13.57 to -0.11; I2 = 95%). In contrast, analyses for length of ICU stay (WMD, -0.12, 95% CI -1.77 to 1.52; I2 = 0%), duration of MV (WMD, -0.34 days; 95% CI, -1.72 to 1.04; I2 = 0%) and mortality (RR, 1.13; 95% CI 0.82 to 1.56; I2 = 0%) were not statistically significant. Quality of evidence ranged from low to very low, and only one study was judged as at low risk of bias. CONCLUSIONS In this meta-analysis, GCFs were significantly associated with lower insulin requirements and improved glycemic control. Although results for clinical outcomes were not statistically significant, there is insufficient evidence to confirm or exclude important differences due to serious imprecision in the effect estimates and overall low quality of evidence. The effects of GCFs on clinical outcomes require confirmation in larger randomized trials.
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Affiliation(s)
- Igor Eckert
- Nutrition Undergraduate Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil
| | - Magali C C Kumbier
- Graduate Program on Medical Sciences: Endocrinology, Faculdade de Medicina, Universidade Federal Do Rio Grande Do Sul (UFRGS), Rio Grande do Sul, Brazil
| | - Flávia M Silva
- Department of Nutrition and Postgraduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil.
| | - Oellen S Franzosi
- Nutrition and Dietetic Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Jussara C de Almeida
- Graduate Program on Medical Sciences: Endocrinology, Faculdade de Medicina, Universidade Federal Do Rio Grande Do Sul (UFRGS), Rio Grande do Sul, Brazil; Division of Nutrition and Dietetics, Hospital de Clínicas de Porto Alegre (HCPA), Rio Grande do Sul, Brazil; Department of Nutrition, Faculdade de Medicina, Universidade Federal Do Rio Grande Do Sul, Rio Grande do Sul (UFRGS), Brazil
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13
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Schiano C, Grimaldi V, Scognamiglio M, Costa D, Soricelli A, Nicoletti GF, Napoli C. Soft drinks and sweeteners intake: Possible contribution to the development of metabolic syndrome and cardiovascular diseases. Beneficial or detrimental action of alternative sweeteners? Food Res Int 2021; 142:110220. [PMID: 33773688 DOI: 10.1016/j.foodres.2021.110220] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 02/02/2021] [Accepted: 02/05/2021] [Indexed: 01/04/2023]
Abstract
The rapid increase in obesity, metabolic syndrome, and cardiovascular diseases (CVDs) has been related to the rise in sugar-added foods and sweetened beverages consumption. An interesting approach has been to replace sugar with alternative sweeteners (AS), due to their impact on public health. Preclinical and clinical studies, which analyze the safety of AS intake, are still limited. Major pathogenic mechanisms of these substances include ROS and AGEs formation. Indeed, endothelial dysfunction involving in the pathogenesis of micro- and macro-vascular diseases is mitochondrial dysfunction dependent. Hyperglycemia and endoplasmic reticulum stress together produce ROS, contributing to the development and progression of cardiovascular complications during type 2 diabetes (T2D), thus causing oxidative changes and direct damage of lipids, proteins, and DNA. Epidemiological studies in healthy subjects have suggested that the consumption of artificial AS can promote CV complications, such as glucose intolerance and predisposition to the onset of T2D, whereas natural AS could reduce hyperglycemia, improve lipid metabolism and have antioxidant effects. Long-term prospective clinical randomized studies are needed to evaluate precisely whether exposure to alternative sugars can have clinical implications on natural history and clinical outcomes, especially in children or during the gestational period through breast milk.
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Affiliation(s)
- Concetta Schiano
- Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania "L. Vanvitelli", Naples, Italy.
| | | | - Michele Scognamiglio
- Clinical Department of Internal Medicine and Specialistic Units, Division of Clinical Immunology and Immunohematology, Transfusion Medicine, and Transplant Immunology [SIMT], Regional Reference Laboratory of Transplant Immunology [LIT], Azienda Universitaria Policlinico (AOU), Naples, Italy
| | - Dario Costa
- Clinical Department of Internal Medicine and Specialistic Units, Division of Clinical Immunology and Immunohematology, Transfusion Medicine, and Transplant Immunology [SIMT], Regional Reference Laboratory of Transplant Immunology [LIT], Azienda Universitaria Policlinico (AOU), Naples, Italy
| | - Andrea Soricelli
- IRCCS SDN, Naples, Italy; Department of Exercise and Wellness Sciences, University of Naples Parthenope, Naples, Italy
| | - Giovanni Francesco Nicoletti
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, Plastic Surgery Unit, University of Campania "L. Vanvitelli", Naples, Italy
| | - Claudio Napoli
- Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania "L. Vanvitelli", Naples, Italy; IRCCS SDN, Naples, Italy; Clinical Department of Internal Medicine and Specialistic Units, Division of Clinical Immunology and Immunohematology, Transfusion Medicine, and Transplant Immunology [SIMT], Regional Reference Laboratory of Transplant Immunology [LIT], Azienda Universitaria Policlinico (AOU), Naples, Italy
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14
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Wei T, Jia Y, Xue W, Ma M, Wu W. Nutritional Effects of the Enteral Nutritional Formula on Regulation of Gut Microbiota and Metabolic Level in Type 2 Diabetes Mellitus Mice. Diabetes Metab Syndr Obes 2021; 14:1855-1869. [PMID: 33953585 PMCID: PMC8089093 DOI: 10.2147/dmso.s301454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/26/2021] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Due to the adverse effects of antidiabetic drugs, nowadays, nutraceuticals have been of much interest to investigators. Therefore, the present study aimed to explore the potential effects of enteral nutritional (EN) formulas on the gut microbiota and metabolic regulation of type 2 diabetes mellitus (T2DM) mice and compare the differences between whey protein and soy protein. METHODS EN formulas made of whey protein or soy protein were administered for five weeks and then mice tissue samples were obtained to examine the metabolic parameters and histopathology of the pancreas, liver, jejunum and colon. 16S rRNA V3-V4 region gene sequencing was used to analyze the changes in the gut microbiota. RESULTS After the five-week intervention, the alpha diversity had recovered slightly, and the soy protein group (SPG) achieved a better effect than the whey protein group (LPG). The overall composition of gut microbiota was regulated. The abundance of Bacteroidetes and TM7 had raised significantly and the abundance of Firmicutes and Deferribacteres had declined after treatment, with no significant difference between the LPG and SPG. The types of beneficial bacteria were increased at the genus and species level. The level of hexokinase (HK) and pyruvate kinase (PK) had significantly recovered and inhibited the level of α-glucosidase. In addition, the EN formulas treatment reduced the levels of inflammatory factor (TNF-α) in liver and muscle. The level of glucose transporter type 2 (GLUT-2) levels in the liver and intestine also significantly increased. Moreover, the metabolism regulation of the SPG was better than that of the LPG. The EN formulas treatment improved the pancreas, liver, jejunum and colon histology. CONCLUSION The EN formulas regulated the overall structure of the gut microbiota and improved the metabolic level in streptozotocin/high-fat diet (STZ/HFD) diabetic mice. Therefore, EN formula may potentially become an effective nutritional adjunctive therapy for T2DM.
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Affiliation(s)
- Ting Wei
- College of Food Science and Engineering, Shanghai Ocean University, Shanghai, 201306, People’s Republic of China
| | - Ye Jia
- College of Food Science and Engineering, Shanghai Ocean University, Shanghai, 201306, People’s Republic of China
| | - Wei Xue
- College of Food Science and Engineering, Shanghai Ocean University, Shanghai, 201306, People’s Republic of China
| | - Ming Ma
- College of Food Science and Engineering, Shanghai Ocean University, Shanghai, 201306, People’s Republic of China
- Correspondence: Ming Ma; Wenhui Wu College of Food Science and Engineering, Shanghai Ocean University, No. 999, Huchenghuan Road, Nanhui New City, Shanghai, 201306, People’s Republic of ChinaTel +86-21-61900296 Email ;
| | - Wenhui Wu
- College of Food Science and Engineering, Shanghai Ocean University, Shanghai, 201306, People’s Republic of China
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15
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Diabetes-specific formulas high in monounsaturated fatty acids and metabolic outcomes in patients with diabetes or hyperglycaemia. A systematic review and meta-analysis. Clin Nutr 2020; 39:3273-3282. [DOI: 10.1016/j.clnu.2020.02.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 01/24/2020] [Accepted: 02/27/2020] [Indexed: 02/06/2023]
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc20-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc20-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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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. Nutrients 2019; 11:nu11081905. [PMID: 31443185 PMCID: PMC6722646 DOI: 10.3390/nu11081905] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/09/2019] [Accepted: 08/12/2019] [Indexed: 12/29/2022] Open
Abstract
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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18
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Laesser CI, Cumming P, Reber E, Stanga Z, Muka T, Bally L. Management of Glucose Control in Noncritically Ill, Hospitalized Patients Receiving Parenteral and/or Enteral Nutrition: A Systematic Review. J Clin Med 2019; 8:jcm8070935. [PMID: 31261760 PMCID: PMC6678336 DOI: 10.3390/jcm8070935] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 12/25/2022] Open
Abstract
Hyperglycemia is a common occurrence in hospitalized patients receiving parenteral and/or enteral nutrition. Although there are several approaches to manage hyperglycemia, there is no consensus on the best practice. We systematically searched PubMed, Embase, Cochrane Central, and ClinicalTrials.gov to identify records (published or registered between April 1999 and April 2019) investigating strategies to manage glucose control in adults receiving parenteral and/or enteral nutrition whilst hospitalized in noncritical care units. A total of 15 completed studies comprising 1170 patients were identified, of which 11 were clinical trials and four observational studies. Diabetes management strategies entailed adaptations of nutritional regimens in four studies, while the remainder assessed different insulin regimens and administration routes. Diabetes-specific nutritional regimens that reduced glycemic excursions, as well as algorithm-driven insulin delivery approaches that allowed for flexible glucose-responsive insulin dosing, were both effective in improving glycemic control. However, the assessed studies were, in general, of limited quality, and we see a clear need for future rigorous studies to establish standards of care for patients with hyperglycemia receiving nutrition support.
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Affiliation(s)
- Céline Isabelle Laesser
- Department of Diabetes, Endocrinology, Clinical Nutrition, and Metabolism, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Paul Cumming
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
- School of Psychology and Counselling and IHBI, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Emilie Reber
- Department of Diabetes, Endocrinology, Clinical Nutrition, and Metabolism, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Zeno Stanga
- Department of Diabetes, Endocrinology, Clinical Nutrition, and Metabolism, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Taulant Muka
- Institute of Social and Preventive Medicine, University of Bern, 3012 Bern, Switzerland
| | - Lia Bally
- Department of Diabetes, Endocrinology, Clinical Nutrition, and Metabolism, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland.
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Angarita Dávila L, Bermúdez V, Aparicio D, Céspedes V, Escobar MC, Durán-Agüero S, Cisternas S, de Assis Costa J, Rojas-Gómez D, Reyna N, López-Miranda J. Effect of Oral Nutritional Supplements with Sucromalt and Isomaltulose versus Standard Formula on Glycaemic Index, Entero-Insular Axis Peptides and Subjective Appetite in Patients with Type 2 Diabetes: A Randomised Cross-Over Study. Nutrients 2019; 11:E1477. [PMID: 31261732 PMCID: PMC6683048 DOI: 10.3390/nu11071477] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/21/2019] [Accepted: 06/24/2019] [Indexed: 12/25/2022] Open
Abstract
Oral diabetes-specific nutritional supplements (ONS-D) induce favourable postprandial responses in subjects with type 2 diabetes (DM2), but they have not been correlated yet with incretin release and subjective appetite (SA). This randomised, double-blind, cross-over study compared postprandial effects of ONS-D with isomaltulose and sucromalt versus standard formula (ET) on glycaemic index (GI), insulin, glucose-dependent insulinotropic polypeptide (GIP), glucagon-like peptide 1 (GLP-1) and SA in 16 individuals with DM2. After overnight fasting, subjects consumed a portion of supplements containing 25 g of carbohydrates or reference food. Blood samples were collected at baseline and at 30, 60, 90, 120, 150 and 180 min; and SA sensations were assessed by a visual analogue scale on separate days. Glycaemic index values were low for ONS-D and intermediate for ET (p < 0.001). The insulin area under the curve (AUC0-180 min) (p < 0.02) and GIP AUC (p < 0.02) were lower after ONS-D and higher GLP-1 AUC when compared with ET (p < 0.05). Subjective appetite AUC was greater after ET than ONS-D (p < 0.05). Interactions between hormones, hunger, fullness and GI were found, but not within the ratings of SA; isomaltulose and sucromalt may have influenced these factors.
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Affiliation(s)
- Lisse Angarita Dávila
- Escuela de Nutrición y Dietética, Facultad de Medicina, Universidad Andres Bello, Sede Concepción 4260000, Chile.
| | - Valmore Bermúdez
- Facultad de Ciencias de la Salud, Universidad Simón Bolívar, Barranquilla 080003, Colombia
| | - Daniel Aparicio
- Centro de Investigaciones Endocrino-Metabólicas "Dr. Félix Gómez", Escuela de Medicina. Facultad de Medicina, Universidad del Zulia, Maracaibo 4001, Venezuela
| | - Virginia Céspedes
- Departamento de Medicina Física y Rehabilitación, Hospital "12 de Octubre", Madrid 28041, Spain
| | - Ma Cristina Escobar
- Escuela de Nutrición y Dietética, Facultad de Medicina, Universidad Andres Bello, Sede Concepción 4260000, Chile
| | - Samuel Durán-Agüero
- Escuela de Nutrición y Dietética, Facultad de Ciencias para el Cuidado de la Salud, Universidad San Sebastián, Santiago 7500000, Chile
| | - Silvana Cisternas
- Escuela de Salud, Universidad Tecnológica de Chile, INACAP, Sede Concepción, Talcahuano 4260000, Chile
| | - Jorge de Assis Costa
- Faculty of Medicine/UniFAGOC, Ubá 36506-022, Minas Gerais, Brazil
- Universidade do Estado de Minas Gerais (UEMG), Barbacena 36202-284, Minas Gerais, Brazil
| | - Diana Rojas-Gómez
- Escuela de Nutrición y Dietética, Facultad de Medicina, Universidad Andres Bello, Santiago 8370321, Chile
| | - Nadia Reyna
- Centro de Investigaciones Endocrino-Metabólicas "Dr. Félix Gómez", Escuela de Medicina. Facultad de Medicina, Universidad del Zulia, Maracaibo 4001, Venezuela
| | - Jose López-Miranda
- Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Cordoba, Reina Sofia University Hospital, University of Córdoba, 14004 Córdoba, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
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20
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Matia Martin P, Robles Agudo F, Lopez Medina JA, Sanz Paris A, Tarazona Santabalbina F, Domenech Pascual JR, Lopez Penabad L, Sanz Barriuso R. Effectiveness of an oral diabetes-specific supplement on nutritional status, metabolic control, quality or life, and functional status in elderly patients. A multicentre study. Clin Nutr 2019; 38:1253-1261. [DOI: 10.1016/j.clnu.2018.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 03/13/2018] [Accepted: 05/04/2018] [Indexed: 12/20/2022]
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The Effect of Enteral Tube Feeding on Patients' Health-Related Quality of Life: A Systematic Review. Nutrients 2019; 11:nu11051046. [PMID: 31083338 PMCID: PMC6566785 DOI: 10.3390/nu11051046] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 12/28/2022] Open
Abstract
Patients with functional gastrointestinal tract who are unable to meet their nutritional requirements may benefit from the use of enteral nutrition via feeding tubes which could be nasogastric, percutaneous endoscopic gastrostomy and jejunostomy. Although enteral tube feeding has been shown to promote nutritional status, improve wound healing, and enhance patients’ quality of life (QoL), evidence of tube and feed complications and reduced QoL has also been reported. Despite the increasing prevalence of patients on enteral tube feeding, no systematic review examining the role of enteral tube feeding on patients’ QoL appears to have been published. Aim: The aim of this systematic review is to evaluate the effect of enteral tube feeding on patients’ QoL. Method: Three databases (EMBASE, Pubmed, and PsycINFO) plus Google Scholar were searched for relevant articles based on the Population, Intervention, Comparator, Outcomes (PICO) framework. The review was in line with preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines and involved the use of synonyms and medical subject headings. In addition, search terms were combined using Boolean operators (AND/OR) and all the articles retrieved were exported to EndNote for de-duplication. Results: Fourteen articles which met the criteria were included and three distinct areas were identified: the effect of early versus late enteral tube feeding on QoL; the QoL of patients on gastrostomy versus standard care, and the effect of enteral tube feeding on QoL. Overall, nine studies reported improvement in the QoL of patients on enteral tube feeding, while five studies demonstrated either no significant difference or reduction in QoL. Some factors which may have influenced these outcomes are differences in types of gastrostomy tubes, enteral feeding methods (including time patients spent connected to enteral feed/pump), and patients’ medical conditions, as well as the generic and/or type of QoL measuring instrument used. Conclusion: Most reviewed studies suggest that enteral tube feeding is effective in improving patients’ QoL. The use of enteral tube feeding-specific QoL measuring instruments is recommended for future research, and improved management strategies including use of mobile enteral feeding pumps should further enhance patients’ QoL. More studies on the effect of delivery systems/enteral feeding pumps on QoL are needed as research in this area is limited.
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22
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López-Gómez JJ, Delgado-García E, Coto-García C, Torres-Torres B, Gómez-Hoyos E, Serrano-Valles C, Castro-Lozano Á, Arenillas-Lara JF, de Luis-Román DA. Influence of Hyperglycemia Associated with Enteral Nutrition on Mortality in Patients with Stroke. Nutrients 2019; 11:E996. [PMID: 31052350 PMCID: PMC6567189 DOI: 10.3390/nu11050996] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 04/28/2019] [Accepted: 04/29/2019] [Indexed: 12/30/2022] Open
Abstract
Objectives: To evaluate in patients admitted for stroke: (1) The frequency of hyperglycaemia associated with enteral nutrition (EN). (2) The risk of morbidity and mortality associated with the development of this type of hyperglycaemia. METHODS A longitudinal observational study was conducted in 115 non-diabetic patients admitted for stroke with EN. Age, functional capacity (Rankin scale), and blood plasma glucose (BPG) were recorded. Hyperglycaemia was considered as: a value higher than 126 mg/dL before the EN and/or a value higher than 150 mg/dL after a week of enteral nutrition. According to this, three groups were differentiated: HyperES: Those who had hyperglycemia before the beginning of the EN (33% patients); NoHyper: those who did not have hyperglycemia before or after (47.8% patients); and HyperEN: Those who did not have hyperglycemia before but suffered it after the beginning of the EN (19.1% patients). RESULTS The age was 72.72 (15.32) years. A higher rate of mortality was observed in the HyperEN group 45.50%, than HyperES 15.80% or NoHyper: 10.90%). A lower recovery of the oral feeding was observed in those patients of the HyperEN group 27.30%, than HyperES: 42.10% or NoHyper: 61.80%). In the multivariate analysis adjusting for age, sex, and Rankin scale the development of hyperglycemia in those who did not have it at the beginning (HyperEN) was an independent risk factor for non-recovery of the oral feeding (OR: 4.21 (1.20-14.79), p = 0.02); and mortality adjusted for age, sex and Rankin scale (OR: 6.83 (1.76-26.47), p < 0.01). CONCLUSIONS In non-diabetic patients admitted for stroke with EN, the development of hyperglycaemia in relation to enteral nutrition supposes an independent risk factor for mortality and for the non-recovery of the oral feeding.
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Affiliation(s)
- Juan José López-Gómez
- Servicio de Endocrinología y Nutrición. Hospital Clínico Universitario Valladolid (HCUV), Valladolid 47003, Spain.
- Centro de Investigación Endocrinología y Nutrición, Valladolid 47003, Spain.
| | - Esther Delgado-García
- Servicio de Endocrinología y Nutrición. Hospital Clínico Universitario Valladolid (HCUV), Valladolid 47003, Spain.
- Centro de Investigación Endocrinología y Nutrición, Valladolid 47003, Spain.
| | | | - Beatriz Torres-Torres
- Servicio de Endocrinología y Nutrición. Hospital Clínico Universitario Valladolid (HCUV), Valladolid 47003, Spain.
- Centro de Investigación Endocrinología y Nutrición, Valladolid 47003, Spain.
| | - Emilia Gómez-Hoyos
- Servicio de Endocrinología y Nutrición. Hospital Clínico Universitario Valladolid (HCUV), Valladolid 47003, Spain.
- Centro de Investigación Endocrinología y Nutrición, Valladolid 47003, Spain.
| | - Cristina Serrano-Valles
- Servicio de Endocrinología y Nutrición. Hospital Clínico Universitario Valladolid (HCUV), Valladolid 47003, Spain.
- Centro de Investigación Endocrinología y Nutrición, Valladolid 47003, Spain.
| | - Ángeles Castro-Lozano
- Servicio de Endocrinología y Nutrición. Hospital Clínico Universitario Valladolid (HCUV), Valladolid 47003, Spain.
- Centro de Investigación Endocrinología y Nutrición, Valladolid 47003, Spain.
| | - Juan F Arenillas-Lara
- Servicio de Neurología. Hospital Clínico Universitario Valladolid (HCUV), Valladolid 47003, Spain.
- Instituto de Biología y Genética Molecular (IBGM), Valladolid 47003, Spain.
| | - Daniel A de Luis-Román
- Servicio de Endocrinología y Nutrición. Hospital Clínico Universitario Valladolid (HCUV), Valladolid 47003, Spain.
- Centro de Investigación Endocrinología y Nutrición, Valladolid 47003, Spain.
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23
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Raveendran AV, Chacko EC, Pappachan JM. Non-pharmacological Treatment Options in the Management of Diabetes Mellitus. EUROPEAN ENDOCRINOLOGY 2018; 14:31-39. [PMID: 30349592 PMCID: PMC6182920 DOI: 10.17925/ee.2018.14.2.31] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 06/13/2018] [Indexed: 02/05/2023]
Abstract
The global prevalence of diabetes, especially type 2 diabetes mellitus, has reached epidemic proportions in the last few decades of the 20th century because of the obesity pandemic resulting from adverse lifestyles. Diabetes as a consequence of obesity (diabesity), continues to increase exponentially in the 21st century. Although there are a multitude of drugs for the effective management of diabesity with modest benefits, most patients will require insulin for control of diabetes at some stage that would worsen obesity, and thereby diabesity. Therefore, effective non-pharmacological therapy needs to be expedited in all patients with diabesity. These measures include medical nutrition interventions, change of lifestyles and bariatric surgery. Non-pharmacological interventions are also useful for the effective management of even type 1 diabetes mellitus when used along with insulin therapy especially in those with obesity. This review summarises the current evidence base for the non-pharmacological interventions in the management of diabetes.
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Affiliation(s)
| | - Elias C Chacko
- Department of Endocrinology, Jersey General Hospital, Jersey
| | - Joseph M Pappachan
- Department of Endocrinology, Diabetes & Metabolism, University Hospitals of Morecambe Bay NHS Foundation Trust, UK
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Vallumsetla N, Epp L, Hurt RT, Mundi MS. Effect of Home Enteral Nutrition on Diabetes and Its Management. Nutr Clin Pract 2018; 34:250-256. [PMID: 30004594 DOI: 10.1002/ncp.10104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is estimated to affect 9% of Americans and is associated with significant morbidity, mortality, and increased healthcare costs. METHODS A retrospective review of a home enteral nutrition (HEN) database of patients seen between March 1, 2004, and April 31, 2014, at our institution was conducted to identify HEN patients who had a diagnosis of DM or were diagnosed within the acute period (4 months) of starting HEN therapy. RESULTS 174 (3.7%) of 4682 patients in the HEN program had DM. HEN was provided through a gastrostomy tube in 82 patients and through a jejunostomy tube in 92 patients. At 3 months, data were available for 42 gastrostomy patients; 44% had a change in DM management, with 60% undergoing a change to insulin. Similarly, 34 patients with jejunostomy had data available, with 41% undergoing change in medication and 93% being changed to insulin therapy. For patients with available glycated hemogloblin values, at 3 months the gastrostomy patients noted a decrease of 0.5% (7.3% ± 1.1% to 6.8% ± 0.7%, not significant) and the jejunostomy patients noted a decrease of 0.4% (6.9% ± 0.9% to 6.5% ± 1.1%, P = .06). CONCLUSIONS Overall, our results suggest that closer follow-up and laboratory assessment are necessary for management of HEN patients with DM. In those with data available, glycemic control can be maintained in patients receiving HEN with appropriate adjustment of DM management and focus on ensuring that patients are not overfed.
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Affiliation(s)
- Nishanth Vallumsetla
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Lisa Epp
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan T Hurt
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA.,Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.,Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, Louisville, Kentucky, USA
| | - Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
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The Effect of Dietary Glycaemic Index on Glycaemia in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients 2018; 10:nu10030373. [PMID: 29562676 PMCID: PMC5872791 DOI: 10.3390/nu10030373] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/07/2018] [Accepted: 03/15/2018] [Indexed: 01/12/2023] Open
Abstract
Background: The increasing prevalence of diabetes in the United Kingdom and worldwide calls for new approaches to its management, and diets with low glycaemic index have been proposed as a useful means for managing glucose response. However, there are conflicting reports and differences in the results of studies in terms of their effectiveness. Furthermore, the impact of low-glycaemic index diets and their long-term use in patients with type 2 diabetes remains unclear. Objectives: The objective of this study was to conduct a systematic review and meta-analysis of the effect of low-glycaemic index diets in patients with type 2 diabetes. Methods: Search methods: Randomised controlled studies were selected from a number of databases (EBSCOHost with links to Health Research databases, PubMed, and grey literature) based on the Population, Intervention, Comparator, Outcomes and Study designs (PICOS) framework. The search terms included synonyms and Medical Subject Headings (MeSH) and involved the use of Boolean operators (AND/OR) which allowed the combination of words and search terms. Selection criteria: As per the selection criteria, the following types of articles were selected: studies on randomised controlled trials, with year of publication between 2008 and 2018, including patients with type 2 diabetes. Thus, studies involving patients with gestational and type 1 diabetes were excluded, as were observational studies. Nine articles which met the inclusion criteria were selected for the systematic review, whereas only six articles which met the criteria were included in the meta-analysis. Data collection and analysis: Studies were evaluated for quality and risk of bias. In addition, heterogeneity, meta-analysis, and sensitivity tests of the extracted data were carried out using Review Manager 5.3 (Review Manager, 2014). Results: The findings of the systematic review showed that the low-glycaemic index (low-GI) diet resulted in a significant improvement (<0.05) in glycated haemoglobin (HbA1c) in two studies: low-GI diet Δ = −0.5% (95% CI, −0.61% to −0.39%) vs. high-cereal fibre diet Δ = −0.18% (95% CI, −0.29% to −0.07%); and low-GI legume diet Δ = −0.5% (95%, −0.6% to −0.4%) vs. high-wheat fibre diet Δ = −0.3% (95% Cl, −0.4 to −0.2%). There was a slight improvement in one study (low glycaemic response = 6.5% (6.3–7.1) vs. control = 6.6% (6.3–7.0) and no significant difference (p > 0.05) in four studies compared with the control diet. Four studies showed improvements in fasting blood glucose in low-GI diets compared to higher-GI diets or control: low-GI diet = 150.8 ± 8.7 vs. higher-GI diet = 157.8 ± 10.4 mg/dL, mean ± SD p = 0.43; low-GI diet = 127.7 vs. high-cereal fibre diet = 136.8 mg/dL, p = 0.02; low-GI diet = 6.5 (5.6–8.4) vs. standard diabetic diet = 6.7 (6.1–7.5) mmol/L, median and interquartile range p > 0.05; and low-GI diet = 7.3 ± 0.3 vs. conventional carbohydrate exchange diet = 7.7 ± 0.4 mmol/L, mean ± SEM (Standard Error of Mean) p < 0.05. The results of the meta-analysis and sensitivity tests demonstrated significant differences (p < 0.001 and p < 0.001, respectively) between the low-GI diet and the higher-GI diet or control diet in relation to glycated haemoglobin. Differences between the low-GI diet and higher-GI diet or control were significant (p < 0.05) with respect to the fasting blood glucose following meta-analysis. Conclusion: The low-GI diet is more effective in controlling glycated haemoglobin and fasting blood glucose compared with a higher-GI diet or control in patients with type 2 diabetes.
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Li X, Jiang X, Sun J, Zhu C, Bai W. Recent advances of medical foods in China: The opportunities and challenges under standardization. Food Chem Toxicol 2018; 119:342-354. [PMID: 29452191 DOI: 10.1016/j.fct.2018.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 02/06/2018] [Accepted: 02/08/2018] [Indexed: 12/24/2022]
Abstract
Malnutrition with high incidence in hospitalized patients in China has brought a significant burden of disease. Although many clinical studies have demonstrated the importance of nutritional for patients with malnutrition, the application of medical foods in China is still restricted. For the classification, limits, production and registration of medical foods, the Chinese government newly enacted a series of regulations. In this review, comparing the policy, researches, and product variety of medical foods in China with other countries, although the current status of the development of medical foods in China is still far behind that of developed countries, some of regulations are stricter than those of many other countries or organizations. The medical foods in China are divided into four categories, the nutrients and environmental contaminants are limited to ensure the safety. As a prospect, the development of medical foods in China is expected to get out of the predicament of lack of emphasis, shortage of supply, backward of local processing technology and the imperfect management system. After all, in view of the huge population and the increasing demand of nutrition in China, there must be a very good prospect for the future development of the medical foods industry in China.
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Affiliation(s)
- Xusheng Li
- Department of Food Science and Engineering, Institute of Food Safety and Nutrition, Guangdong Engineering Technology Center of Food Safety Molecular Rapid Detection, Jinan University, Guangzhou 510632, PR China
| | - Xinwei Jiang
- Department of Food Science and Engineering, Institute of Food Safety and Nutrition, Guangdong Engineering Technology Center of Food Safety Molecular Rapid Detection, Jinan University, Guangzhou 510632, PR China
| | - Jianxia Sun
- School of Chemical Engineering and Light Industry, Guangdong University of Technology, Guangzhou 510090, PR China
| | - Cuijuan Zhu
- Department of Food Science and Engineering, Institute of Food Safety and Nutrition, Guangdong Engineering Technology Center of Food Safety Molecular Rapid Detection, Jinan University, Guangzhou 510632, PR China
| | - Weibin Bai
- Department of Food Science and Engineering, Institute of Food Safety and Nutrition, Guangdong Engineering Technology Center of Food Safety Molecular Rapid Detection, Jinan University, Guangzhou 510632, PR China.
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Durán Agüero S, Angarita Dávila L, Escobar Contreras MC, Rojas Gómez D, de Assis Costa J. Noncaloric Sweeteners in Children: A Controversial Theme. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4806534. [PMID: 29511682 PMCID: PMC5817296 DOI: 10.1155/2018/4806534] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/05/2017] [Accepted: 09/19/2017] [Indexed: 12/17/2022]
Abstract
Noncaloric sweeteners (NCS) are food additives used to provide sweetness without adding calories. Their consumption has become more widespread around the world in all age groups, including children. The aim of this study is to show the state of the art about the intake of noncaloric sweeteners in children, as well as their benefits and consumption risk. Scientific searchers were used (PUBMED, Scopus, and Scielo) to analyze articles that included keywords (noncaloric sweeteners/saccharin/cyclamate/acesulfame potassium/aspartame/sucralose/stevia/children) in English, Spanish, and Portuguese. Authors conclude that it is imperative that health professionals judiciously and individually evaluate the overall benefits and risks of NCS use in consumers before recommending their use. Different subgroups of the population incorporate products containing NCS in their diet with different objectives, which should be considered when recommending a diet plan for the consumer. In childhood, in earlier age groups, this type of additives should be used as a dietary alternative when other forms of prevention in obesity are not sufficient.
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Affiliation(s)
- Samuel Durán Agüero
- Escuela de Nutrición y Dietética, Facultad de Ciencias de la Salud, Universidad San Sebastián, Santiago de Chile, Chile
| | - Lissé Angarita Dávila
- Carrera de Nutrición y Dietética, Facultad de Medicina, Universidad Andres Bello, Sede Concepción, Talcahuano, Chile
| | | | - Diana Rojas Gómez
- Escuela de Nutrición y Dietética, Facultad de Medicina, Universidad Andres Bello, Santiago, Chile
| | - Jorge de Assis Costa
- Faculdade de Medicina/FAGOC, Ubá, MG, Brazil
- Universidade Estadual de Minas Gerais (UEMG), Barbacena, MG, Brazil
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Han YY, Lai SR, Partridge JS, Wang MY, Sulo S, Tsao FW, Hegazi RA. The clinical and economic impact of the use of diabetes-specific enteral formula on ICU patients with type 2 diabetes. Clin Nutr 2017; 36:1567-1572. [DOI: 10.1016/j.clnu.2016.09.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 09/07/2016] [Accepted: 09/27/2016] [Indexed: 12/12/2022]
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Abstract
PURPOSE OF REVIEW The purpose of this review is to discuss strategies to reduce rates of hypoglycemia in the non-critical care setting. RECENT FINDINGS Strategies to reduce hypoglycemia rates should focus on the most common causes of iatrogenic hypoglycemia. Creating a standardized insulin order set with built-in clinical decision support can help reduce rates of hypoglycemia. Coordination of blood glucose monitoring, meal tray delivery, and insulin administration is an important and challenging task. Protocols and processes should be in place to deal with interruptions in nutrition to minimize risk of hypoglycemia. A glucose management page that has all the pertinent information summarized in one page allows for active surveillance and quick identification of patients who may be at risk of hypoglycemia. Finally, education of prescribers, nurses, food and nutrition services, and patients is important so that every member of the healthcare team can work together to prevent hypoglycemia. By implementing strategies to reduce hypoglycemia, we hope to lower rates of adverse events and improve quality of care while also reducing hospital costs. Future research should focus on the impact of an overall reduction in hypoglycemia to determine whether the expected benefits are achieved.
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Affiliation(s)
- Kristen Kulasa
- Division of Endocrinology, Diabetes, and Metabolism, University of California, San Diego, 200 West Arbor Drive, MC#8409, San Diego, CA, 92103, USA.
| | - Patricia Juang
- Division of Endocrinology, Diabetes, and Metabolism, University of California, San Diego, 200 West Arbor Drive, MC#8409, San Diego, CA, 92103, USA
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Drincic AT, Knezevich JT, Akkireddy P. Nutrition and Hyperglycemia Management in the Inpatient Setting (Meals on Demand, Parenteral, or Enteral Nutrition). Curr Diab Rep 2017; 17:59. [PMID: 28664252 DOI: 10.1007/s11892-017-0882-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW The goal of this paper is to provide the latest evidence and expert recommendations for management of hospitalized patients with diabetes or hyperglycemia receiving enteral (EN), parenteral (PN) nutrition support or, those with unrestricted oral diet, consuming meals on demand. RECENT FINDINGS Patients with and without diabetes mellitus commonly develop hyperglycemia while receiving EN or PN support, placing them at increased risk of adverse outcomes, including in-hospital mortality. Very little new evidence is available in the form of randomized controlled trials (RCT) to guide the glycemic management of these patients. Reduction in the dextrose concentration within parenteral nutrition as well as selection of an enteral formula that diminishes the carbohydrate exposure to a patient receiving enteral nutrition are common strategies utilized in practice. No specific insulin regimen has been shown to be superior in the management of patients receiving EN or PN nutrition support. For those receiving oral nutrition, new challenges have been introduced with the most recent practice allowing patients to eat meals on demand, leading to extreme variability in carbohydrate exposure and risk of hypo and hyperglycemia. Synchronization of nutrition delivery with the astute use of intravenous or subcutaneous insulin therapy to match the physiologic action of insulin in patients receiving nutritional support should be implemented to improve glycemic control in hospitalized patients. Further RCTs are needed to evaluate glycemic and other clinical outcomes of patients receiving nutritional support. For patients eating meals on demand, development of hospital guidelines and policies are needed, ensuring optimization and coordination of meal insulin delivery in order to facilitate patient safety.
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Affiliation(s)
- Andjela T Drincic
- Department of Internal Medicine: Diabetes, Endocrinology and Metabolism, University of Nebraska Medical Center, 984120 Nebraska Medical Center, Omaha, NE, 68198-4120, USA.
| | - Jon T Knezevich
- Department of Pharmaceutical and Nutrition Care, University of Nebraska Medical Center, 984120 Nebraska Medical Center, Omaha, NE, 68198-4120, USA
| | - Padmaja Akkireddy
- Department of Internal Medicine: Diabetes, Endocrinology and Metabolism, University of Nebraska Medical Center, 984120 Nebraska Medical Center, Omaha, NE, 68198-4120, USA
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Barazzoni R, Deutz N, Biolo G, Bischoff S, Boirie Y, Cederholm T, Cuerda C, Delzenne N, Leon Sanz M, Ljungqvist O, Muscaritoli M, Pichard C, Preiser J, Sbraccia P, Singer P, Tappy L, Thorens B, Van Gossum A, Vettor R, Calder P. Carbohydrates and insulin resistance in clinical nutrition: Recommendations from the ESPEN expert group. Clin Nutr 2017; 36:355-363. [DOI: 10.1016/j.clnu.2016.09.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/13/2016] [Accepted: 09/13/2016] [Indexed: 12/17/2022]
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Hijaze D, Szalat A. Retrospective Evaluation of Glycemic Control With Basal-Bolus or Neutral Protamine Hagedorn Insulin Regimens in Patients Receiving Continuous Enteral Nutrition Therapy in Medicine Wards. Nutr Clin Pract 2017; 32:557-562. [PMID: 28760108 DOI: 10.1177/0884533617692765] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Reasonable glycemic control is difficult to achieve in patients with diabetes mellitus (DM) receiving continuous enteral nutrition therapy (CENT). There are no solid evidence-based medicine guidelines regarding this issue in these patients. The purpose of this study was to determine if the use of a basal-bolus insulin regimen is more effective than neutral protamine Hagedorn (NPH) insulin alone in controlling blood glucose in non-critically ill patients with DM receiving CENT. We performed a retrospective, records-based review comparing basal-bolus with NPH insulin regimen in these patients, hospitalized in the internal medicine wards in our hospital. Number of hypoglycemic episodes, mean blood glucose, and time-to-target (time needed to reach 3 successive glucose readings in the appropriate target of 140-180 mg/dL) were evaluated in each regimen. Mean blood glucose was 199.22 mg/dL (95% confidence interval [CI], 179.8-218.5 mg/dL) in the basal-bolus vs 190.73 mg/dL (95% CI, 172.1-209.2 mg/dL) in the NPH insulin regimen ( P = .538). Time-to-target was an average of 3.65 ± 1.75 days in the basal-bolus group and 4.33 ± 2.42 days in the NPH group ( P = .364). There were no statistically significant differences in frequency of hypoglycemia ( P = .364). Rate of death was high (around 40%) in both groups. We conclude that hospitalized hyperglycemic patients receiving CENT can be treated by either basal-bolus or NPH insulin regimens. However, the overall glucose levels remain elevated during hospitalization irrespective of the insulin therapy. There is an urgent need to define glucose targets in this population of patients and to evaluate prospectively head-to-head different insulin protocols.
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Affiliation(s)
- Dema Hijaze
- 1 Internal Medicine Department, Hadassah-Mount Scopus, Hebrew-University Medical Center, Jerusalem, Israel
| | - Auryan Szalat
- 1 Internal Medicine Department, Hadassah-Mount Scopus, Hebrew-University Medical Center, Jerusalem, Israel
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36
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Abstract
There have been significant advances in the provision of enteral nutrition support in the acute and community healthcare settings.[...].
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Health-Care Costs, Glycemic Control and Nutritional Status in Malnourished Older Diabetics Treated with a Hypercaloric Diabetes-Specific Enteral Nutritional Formula. Nutrients 2016; 8:153. [PMID: 27005661 PMCID: PMC4808881 DOI: 10.3390/nu8030153] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 02/17/2016] [Accepted: 02/29/2016] [Indexed: 12/16/2022] Open
Abstract
Diabetes-specific formulas are an effective alternative for providing nutrients and maintaining glycemic control. This study assesses the effect of treatment with an oral enteral nutrition with a hypercaloric diabetes-specific formula (HDSF) for one year, on health-care resources use, health-care costs, glucose control and nutritional status, in 93 type-2 diabetes mellitus (T2DM) malnourished patients. Changes in health-care resources use and health-care costs were collected the year before and during the year of intervention. Glucose status and nutritional laboratory parameters were analyzed at baseline and one-year after the administration of HDSF. The administration of HDSF was significantly associated with a reduced use of health-care resources, fewer hospital admissions (54.7%; p < 0.001), days spent at hospital (64.1%; p < 0.001) and emergency visits (57.7%; p < 0.001). Health-care costs were reduced by 65.6% (p < 0.001) during the intervention. Glycemic control (short- and long-term) and the need of pharmacological treatment did not change, while some nutritional parameters were improved at one year (albumin: +10.6%, p < 0.001; hemoglobin: +6.4%, p = 0.026). In conclusion, using HDSF in malnourished older type-2 diabetic patients may allow increasing energy intake while maintaining glucose control and improving nutritional parameters. The use of health-care resources and costs were significantly reduced during the nutritional intervention.
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Lansink M, Hofman Z, Genovese S, Rouws CHFC, Ceriello A. Improved Glucose Profile in Patients With Type 2 Diabetes With a New, High-Protein, Diabetes-Specific Tube Feed During 4 Hours of Continuous Feeding. JPEN J Parenter Enteral Nutr 2016; 41:968-975. [PMID: 26826263 DOI: 10.1177/0148607115625635] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Hyperglycemia frequently occurs in hospitalized patients receiving nutrition support. In this study, the effects of a new diabetes-specific formula (DSF) on glucose profile during 4 hours of continuous feeding and 4 hours after stopping feeding were compared with a standard formula (SF). MATERIALS AND METHODS In this randomized, controlled, double-blind, crossover study, ambulant, nonhospitalized patients with type 2 diabetes received the DSF or an isocaloric, fiber-containing SF via a nasogastric tube. After overnight fasting, the formula was continuously administered to the patients during 4 hours. Plasma glucose and insulin concentrations were determined during the 4-hour period and in the subsequent 4 hours during which no formula was provided. RESULTS During the 4-hour feeding period, DSF compared with SF resulted in a lower mean delta glucose concentration in the 3- to 4-hour period (0.3 ± 1.0 and 2.4 ± 1.5 mmol/L; P < .001). Also, the (delta) peak concentrations, (delta) mean concentrations, and incremental area under the curve (iAUC) for glucose and insulin were significantly lower during DSF compared with SF feeding (all comparisons: P < .001). Furthermore, fewer patients experienced hyperglycemia (>10 mmol/L) on DSF compared with SF (2 vs 11, P = .003, respectively). No differences in number of patients with hypoglycemia (<3.9 mmol/L) were observed. No significant differences in tolerance were observed. CONCLUSION Administration of a new, high-protein DSF during 4 hours of continuous feeding resulted in lower glucose and insulin levels compared with a fiber-containing SF in ambulant, nonhospitalized patients with type 2 diabetes. These data suggest that a DSF may contribute to lower glucose levels in these patients.
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Affiliation(s)
- Mirian Lansink
- 1 Nutricia Research, Nutricia Advanced Medical Nutrition, Utrecht, the Netherlands
| | - Zandrie Hofman
- 1 Nutricia Research, Nutricia Advanced Medical Nutrition, Utrecht, the Netherlands
| | - Stefano Genovese
- 2 Department of Cardiovascular and Metabolic Diseases, IRCCS Gruppo Multimedica, Sesto San Giovanni (MI), Italy
| | - Carlette H F C Rouws
- 1 Nutricia Research, Nutricia Advanced Medical Nutrition, Utrecht, the Netherlands
| | - Antonio Ceriello
- 3 Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,4 Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
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