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

A systematic review and meta-analysis

¹ Instutite of Human Nutrition, University of Southampton, Southampton, U.K.
² Department of Pathology and Medicine (Experimental and Clinical), University of Udine, Udine, Italy
³ Department of Internal Medicine, University of Giessen, Giessen, Germany
⁴ Section of Geriatric Medicine and Gerontology, Diabetes Research Unit, Centre for Health Services, University of Warwick, Warwick, U.K.
⁵ Clinical Nutrition Division, Royal Numico, Amsterdam, the Netherlands

Address correspondence and reprint requests to Prof. Marinos Elia, Institute of Human Nutrition, University of Southampton, Southampton General Hospital, MP 113 F Level, Tremona Road, Southampton, SO16 6YD, U.K. E-mail: m.elia{at}soton.ac.uk

OBJECTIVE—The aim of this systematic review was to determine the benefits of nutritional support in patients with type 1 or type 2 diabetes.

RESEARCH DESIGN AND METHODS—Studies utilizing an enteral nutritional support intervention (oral supplements or tube feeding) were identified using electronic databases and bibliography searches. Comparisons of interest were nutritional support versus routine care and standard versus diabetes-specific formulas (containing high proportions of monounsaturated fatty acids, fructose, and fiber). Outcomes of interest were measures of glycemia and lipid status, medication requirements, nutritional status, quality of life, complications, and mortality. Meta-analyses were performed where possible.

RESULTS—A total of 23 studies (comprising 784 patients) of oral supplements (16 studies) and tube feeding (7 studies) were included in the review, and the majority compared diabetes-specific with standard formulas. Compared with standard formulas, diabetes-specific formulas significantly reduced postprandial rise in blood glucose (by 1.03 mmol/l [95% CI 0.58–1.47]; six randomized controlled trials [RCTs]), peak blood glucose concentration (by 1.59 mmol/l [86–2.32]; two RCTs), and glucose area under curve (by 7.96 mmol · l^–1 · min^–1 [2.25–13.66]; four RCTs, i.e., by 35%) with no significant effect on HDL, total cholesterol, or triglyceride concentrations. In addition, individual studies reported a reduced requirement for insulin (26–71% lower) and fewer complications with diabetes-specific compared with standard nutritional formulas.

CONCLUSIONS—This systematic review shows that short- and long-term use of diabetes-specific formulas as oral supplements and tube feeds are associated with improved glycemic control compared with standard formulas. If such nutritional support is given long term, this may have implications for reducing chronic complications of diabetes, such as cardiovascular events.

Abbreviations: AUC, area under the curve • CCT, controlled CT • CT, clinical trial • ETF, enteral tube feeding • MUFA, monounsaturated fatty acid • ONS, oral nutritional supplement • RCT, randomized controlled trial

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