Abstract
Background and objectivesStandard enteral nutrition (EN) formulas can worsen hyperglycemia in diabetic patients. We hypothesized that altering the proportion of macronutrients in a formula; increasing protein while decreasing carbohydrate concentrations would improve glycemic response. The objective of this study was to demonstrate that an EN formula containing a very high concentration of protein (in the form of whey peptides) and low concentration of carbohydrate provide better control of postprandial blood glucose relative to a very high-protein/higher-carbohydrate formula.Subjects and methodsThis was a randomized crossover clinical trial of 12 ambulatory adult subjects with type 2 diabetes. The primary outcome was glycemic response following a bolus of isocaloric amounts of two EN formulas; the secondary outcome was insulin response. Subjects were randomized to the experimental or the control formula, on two separate days, 5–7 days apart.ResultsMean blood glucose concentrations at 10–180 min post-infusion and mean area under the curve for glucose over 240 min post-infusion were significantly lower with the experimental formula than with the control formula (71.99 ± 595.18 and 452.62 ± 351.38, respectively; p = 0.025). There were no significant differences in the mean insulin concentrations over time, insulinogenic indices, and first-phase insulin measurements.ConclusionsAn EN formula containing high-protein and low-carbohydrate loads can significantly improve glucose control in subjects with type 2 diabetes in ambulatory settings as evidenced by observed improved glucose control without significant difference in insulin response.
Highlights
The use of home enteral nutrition (EN) in the UnitedStates has increased dramatically since early 1990s, with 139 per 100,000 individuals estimated to have used home EN in 20131
Mean blood glucose concentrations at 10–180 min post-infusion and mean area under the curve for glucose over 240 min post-infusion were significantly lower with the experimental formula than with the control formula (71.99 ± 595.18 and 452.62 ± 351.38, respectively; p = 0.025)
There were no significant differences in the mean insulin concentrations over time, insulinogenic indices, and first-phase insulin measurements
Summary
The use of home enteral nutrition (EN) in the United. States has increased dramatically since early 1990s, with 139 per 100,000 individuals (of which 56.8% were adults) estimated to have used home EN in 20131. According to Center for Disease Control and Prevention, an estimated 30.3 million individuals (9.4% of the people at least 18 years old) are living with diagnosed or undiagnosed. Huhmann et al Nutrition and Diabetes (2018)8:45. Calories Total protein kcal Amount (g) Source. Standard enteral nutrition (EN) formulas can worsen hyperglycemia in diabetic patients. We hypothesized that altering the proportion of macronutrients in a formula; increasing protein while decreasing carbohydrate concentrations would improve glycemic response. The objective of this study was to demonstrate that an EN formula containing a very high concentration of protein (in the form of whey peptides) and low concentration of carbohydrate provide better control of postprandial blood glucose relative to a very high-protein/highercarbohydrate formula
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