Glycemic Effects of a Low-Carbohydrate Enteral Formula Compared With an Enteral Formula of Standard Composition in Critically Ill Patients: An Open-Label Randomized Controlled Clinical Trial
| Autor: | Sigrid C. van Steen, Peter H. J. van der Voort, J. Hans DeVries, Saskia Rijkenberg, Marjolein K. Sechterberger |
|---|---|
| Přispěvatelé: | Endocrinology, AGEM - Endocrinology, metabolism and nutrition |
| Rok vydání: | 2017 |
| Předmět: |
Blood Glucose
Male medicine.medical_specialty Critical Care Critical Illness Medicine (miscellaneous) Low carbohydrate enteral formula Stress hyperglycemia Gastroenterology Enteral administration Diet Carbohydrate-Restricted 03 medical and health sciences Enteral Nutrition 0302 clinical medicine Dietary Fats Unsaturated Internal medicine Dietary Carbohydrates medicine Humans Insulin Prospective Studies 030212 general & internal medicine Aged Glycemic Nutrition and Dietetics business.industry Glucose Measurement 030208 emergency & critical care medicine medicine.disease Glucerna Standard enteral formula Parenteral nutrition Hyperglycemia Female Dietary Proteins business |
| Zdroj: | JPEN. Journal of parenteral and enteral nutrition, 42(6), 1035-1045. SAGE Publications Inc. |
| ISSN: | 0148-6071 |
| DOI: | 10.1002/jpen.1045 |
| Popis: | Background Enteral low-carbohydrate formulas (LCFs) could serve as a noninsulin alternative for the treatment of stress hyperglycemia in critically ill patients. We compared the glycemic effects of an LCF with a standard formula. Methods We conducted an open-label randomized trial in patients admitted to our intensive care unit between September 2015 and June 2016. Adult patients with an indication for enteral nutrition were randomized to an LCF (Glucerna 1.5 kcal) or a standard enteral formula (Fresubin Energy Fibre, with additional protein supplement). Primary outcome was glucose variability defined as mean absolute glucose (MAG) change (mmol/L/h). Secondary outcomes were mean glucose, time in target, hypoglycemic and hyperglycemic events, and insulin requirements. We assessed glycemic outcomes per blinded continuous glucose monitoring (CGM) system and compared outcomes with glucose measurements per blood gas analysis and point-of-care device. Results We randomized 107 patients (LCF: n = 53; standard: n = 54). Six patients had no CGM data, leaving 101 patients (n = 52; n = 49) for the intention-to-treat analysis. MAG change and time in target range were not different between groups. LCF gave a lower mean glucose measured per point-of-care device (7.8 ± 1.0 vs 8.4 ± 1.1 mmol/L, P = .007). LCF patients required significantly less insulin on the second study day (46.8 vs 68.0 IU, P = .036). Conclusion LCF showed a trend toward a modestly reduced mean glucose and significantly lower insulin requirements as compared with standard feeding but had no effect on glucose variability or time in target range. |
| Databáze: | OpenAIRE |
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