Nutrition in critically ill patients with diabetes

Abstract

Physiologically, any injury that triggers a "critical illness" response is associated with insulin resistance as a result of sympathetic activation, the release of stress hormones, and inflammatory mediators. When patients with diabetes mellitus (DM) are critically ill and admitted to intensive care, glycemic management may be different from that of non-diabetic patients. There are many studies seeking to estimate the best strategy for glycemic control in critically ill patients. Two main strategies have been studied: liberal control with a control target when blood glucose levels are greater than 180 mg/dL, and a stricter one. Liberal control appears to be the most appropriate as it reduces the risk of hypoglycemia, while strict control has not shown any benefits, except in one widely criticized study. It should be noted that these studies do not discriminate between diabetic and non-diabetic patients.

There are many studies seeking to estimate the best strategy for glycemic control in critically ill patients. Two main strategies have been studied: liberal control with a control target when blood glucose levels are greater than 180 mg/dL, and a stricter one. Liberal control appears to be the most appropriate as it reduces the risk of hypoglycemia, while strict control has not shown any benefits, except in one widely criticized study. It should be noted that these studies do not discriminate between diabetic and non-diabetic patients.

Regarding enteral formulas, most DM-specific formulas contain a mixture of complex carbohydrates, such as fructose, corn starch, or fiber, which slow gastric emptying and reduce intestinal transit, thus facilitating better glycemic control. Studies in healthy adults investigating the impact of whey protein have shown an increase in insulin and incretin secretion, which slows gastric emptying and improves glycemic control. However, these effects of slow gastric emptying on glycemic control have not been confirmed in critically ill patients.

In recent years, several studies have investigated the effect of nutritional formulas on glycemic control. Eckert et al. conducted a systematic review and meta-analysis investigating the association between specialized enteral nutrition formulas and glycemic control, as well as clinical outcomes. They found that specialized enteral nutrition formulas facilitated a reduction in insulin use and improved glycemic control. No significant associations with clinical outcomes were found; however, this is likely due to variations in study designs and target groups.