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Enteral nutritional support and use of diabetes-specific formulas for patients with diabetes: a systematic review and meta-analysis.

Abstract

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.

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  • Authors+Show Affiliations

    ,

    Institute of Human Nutrition, University of Southampton, Southampton General Hospital, MP 113 F Level, Tremona Road, Southampton, SO16 6YD, UK. m.elia@soton.ac.uk

    , , , ,

    Source

    Diabetes care 28:9 2005 Sep pg 2267-79

    MeSH

    Blood Glucose
    Diabetes Mellitus
    Diet, Diabetic
    Dietary Supplements
    Enteral Nutrition
    Food, Formulated
    Humans

    Pub Type(s)

    Comparative Study
    Journal Article
    Meta-Analysis
    Research Support, Non-U.S. Gov't
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    16123506

    Citation

    Elia, Marinos, et al. "Enteral Nutritional Support and Use of Diabetes-specific Formulas for Patients With Diabetes: a Systematic Review and Meta-analysis." Diabetes Care, vol. 28, no. 9, 2005, pp. 2267-79.
    Elia M, Ceriello A, Laube H, et al. Enteral nutritional support and use of diabetes-specific formulas for patients with diabetes: a systematic review and meta-analysis. Diabetes Care. 2005;28(9):2267-79.
    Elia, M., Ceriello, A., Laube, H., Sinclair, A. J., Engfer, M., & Stratton, R. J. (2005). Enteral nutritional support and use of diabetes-specific formulas for patients with diabetes: a systematic review and meta-analysis. Diabetes Care, 28(9), pp. 2267-79.
    Elia M, et al. Enteral Nutritional Support and Use of Diabetes-specific Formulas for Patients With Diabetes: a Systematic Review and Meta-analysis. Diabetes Care. 2005;28(9):2267-79. PubMed PMID: 16123506.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Enteral nutritional support and use of diabetes-specific formulas for patients with diabetes: a systematic review and meta-analysis. AU - Elia,Marinos, AU - Ceriello,Antonio, AU - Laube,Heiner, AU - Sinclair,Alan J, AU - Engfer,Meike, AU - Stratton,Rebecca J, PY - 2005/8/27/pubmed PY - 2005/11/8/medline PY - 2005/8/27/entrez SP - 2267 EP - 79 JF - Diabetes care JO - Diabetes Care VL - 28 IS - 9 N2 - 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. SN - 0149-5992 UR - https://www.unboundmedicine.com/medline/citation/16123506/Enteral_nutritional_support_and_use_of_diabetes_specific_formulas_for_patients_with_diabetes:_a_systematic_review_and_meta_analysis_ L2 - http://care.diabetesjournals.org/cgi/pmidlookup?view=long&pmid=16123506 DB - PRIME DP - Unbound Medicine ER -