RT Journal Article
T1 Diabetes-specific enteral nutrition formula in hyperglycemic, mechanically ventilated, critically ill patients: a prospective, open-label, blind-randomized, multicenter study.
A1 Mesejo, Alfonso
A1 Montejo-González, Juan Carlos
A1 Vaquerizo-Alonso, Clara
A1 Lobo-Tamer, Gabriela
A1 Zabarte-Martinez, Mercedes
A1 Herrero-Meseguer, Jose Ignacio
A1 Acosta-Escribano, Jose
A1 Blesa-Malpica, Antonio
A1 Martinez-Lozano, Fátima
K1 Glucemia
K1 Diabetes Mellitus
K1 Nutrición enteral
K1 Índice glucémico
K1 Humanos
K1 Hiperglucemia
K1 Insulina
K1 Estado nutricional
K1 Estudios prospectivos
K1 Enfermedad crítica
K1 Unidades de cuidados intensivos
AB INTRODUCTIONAlthough standard enteral nutrition is universally accepted, the use of disease-specific formulas for hyperglycemic patients is still controversial. This study examines whether a high-protein diabetes-specific formula reduces insulin needs, improves glycemic control and reduces ICU-acquired infection in critically ill, hyperglycemic patients on mechanical ventilation (MV).METHODSThis was a prospective, open-label, randomized (web-based, blinded) study conducted at nine Spanish ICUs. The patient groups established according to the high-protein formula received were: group A, new-generation diabetes-specific formula; group B, standard control formula; group C, control diabetes-specific formula. Inclusion criteria were: expected enteral nutrition ≥5 days, MV, baseline glucose >126 mg/dL on admission or >200 mg/dL in the first 48 h. Exclusion criteria were: APACHE II ≤10, insulin-dependent diabetes, renal or hepatic failure, treatment with corticosteroids, immunosuppressants or lipid-lowering drugs and body mass index ≥40 kg/m(2). The targeted glucose level was 110-150 mg/dL. Glycemic variability was calculated as the standard deviation, glycemic lability index and coefficient of variation. Acquired infections were recorded using published consensus criteria for critically ill patients. Data analysis was on an intention-to-treat basis.RESULTSOver a 2-year period, 157 patients were consecutively enrolled (A 52, B 53 and C 52). Compared with the standard control formula, the new formula gave rise to lower insulin requirement (19.1 ± 13.1 vs. 23.7 ± 40.1 IU/day, p <0.05), plasma glucose (138.6 ± 39.1 vs. 146.1 ± 49.9 mg/dL, p <0.01) and capillary blood glucose (146.1 ± 45.8 vs. 155.3 ± 63.6 mg/dL, p <0.001). Compared with the control diabetes-specific formula, only capillary glucose levels were significantly reduced (146.1 ± 45.8 vs. 150.1 ± 41.9, p <0.01). Both specific formulas reduced capillary glucose on ICU day 1 (p <0.01), glucose variability in the first week (p <0.05), and incidences of ventilator-associated tracheobronchitis (p <0.01) or pneumonia (p <0.05) compared with the standard formula. No effects of the nutrition formula were produced on hospital stay or mortality.CONCLUSIONSIn these high-risk ICU patients, both diabetes-specific formulas lowered insulin requirements, improved glycemic control and reduced the risk of acquired infections relative to the standard formula. Compared with the control-specific formula, the new-generation formula also improved capillary glycemia.TRIAL REGISTRATIONClinicaltrials.gov NCT1233726 .
PB BioMed Central
SN 1364-8535
YR 2015
FD 2015-11-09
LK http://hdl.handle.net/10668/2311
UL http://hdl.handle.net/10668/2311
LA en
NO Mesejo A, Montejo-González JC, Vaquerizo-Alonso C, Lobo-Tamer G, Zabarte-Martinez M, Herrero-Meseguer JI, et al. Diabetes-specific enteral nutrition formula in hyperglycemic, mechanically ventilated, critically ill patients: a prospective, open-label, blind-randomized, multicenter study. Crit Care. 2015; 19:390
NO Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't;
DS RISalud
RD Apr 7, 2025