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Glycemic Control in Patients With Type 2 Diabetes Mellitus With a Disease-Specific Enteral Formula: Stage II of a Randomized, Controlled Multicenter Trial

From the ¹ Department of Early Neurological Rehabilitation, Klinik Bavaria, Kreischa, Germany;² Diabetology, Health Care Center, Stockach, Germany;³ Department of Neurological Rehabilitation, Neurological Hospital, Bad Aibling, Germany; ⁴ Diabetes Research Institute, Munich, Germany; ⁵ Center for Neurological Rehabilitation, Median Klinik, Magdeburg, Germany;⁶ Department of Neurology, Neurological Hospital, Bad Neustadt/Saale, Germany; ⁷ Fresenius Kabi, Bad Homburg, Germany; ⁸ Department of Internal Medicine, Herning County Hospital, Herning, Denmark; ⁹ Data Analysis and Planning, IDV, Gauting, Germany.

Address correspondence to: Marcus Pohl, MD, Department of Early Neurological Rehabilitation, Abteilung Frührehabilitation, Klinik Bavaria, An der Wolfsschlucht 1-2, D-01731 Kreischa, Germany; e-mail: marcus.pohl{at}klinik-bavaria.de.

Background: Stage I of a preplanned 2-stage study has provided good evidence for improved glycemic control with a disease-specific enteral formula low in carbohydrates and high in monounsaturated fatty acids (MUFAs), fish oil, chromium, and antioxidants in insulin-treated type 2 diabetes. The study was continued with stage II to give confirmatory proof of these beneficial effects. Methods: 105 patients with HbA_1C 7.0% and/or fasting blood glucose (FG) > 6.7 mmol/L (>120 mg/dL) requiring enteral tube feeding due to neurological dysphagia received 113 kJ (27 kcal)/kg body weight of either test formula (Diben) or an isoenergetic, isonitrogenous standard formula (control) for up to 84 days. Total insulin (TI) requirements, FG, and afternoon blood glucose (AG) were assessed daily. HbA_1C and safety criteria were evaluated on days 1, 28, 56, and 84. Results: 55 patients completed the study; on day 84, median changes from baseline (data as available, test vs control) were the following: TI, –8.0 vs +2.0 IU; FG, –2.17 vs –0.67 mmol/L (–39.0 vs –12.1 mg/dL); HbA_1C, –1.30% vs –1.20%; AG, –2.36 vs –0.49 mmol/L (–42.5 vs –8.9 mg/dL). The number of relevant hypoglycemic episodes (FG < 3.33 mmol/L < 60 mg/dL) was 1 vs 5. Feeding tolerance was comparable in both groups. Conclusions: Long-term tube feeding with a disease-specific enteral formula was safe and well tolerated in type 2 diabetic patients with neurological disorders. When compared with a standard diet, TI requirement decreased significantly with less hypoglycemia whereas FG and AG were significantly lowered, resulting in improved glycemic control.

Key Words: enteral nutrition • diabetes mellitus • carbohydrates • insulin • blood glucose • glycosylated hemoglobin A

This version was published on January 1, 2009

Journal of Parenteral and Enteral Nutrition, Vol. 33, No. 1, 37-49 (2009)
DOI: 10.1177/0148607108324582


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