Wongwatanasanti Kwansuphang, Wichansawakun Sanit
Department of Medicine, Faculty of Medicine, Thammasat University, Pathum-Thani, Thailand.
Division of Clinical Nutrition, Department of Medicine, Faculty of Medicine, Thammasat University, Pathum-Thani, Thailand.
Indian J Endocrinol Metab. 2022 May-Jun;26(3):259-264. doi: 10.4103/ijem.ijem_79_22. Epub 2022 Aug 4.
As malnutrition negatively impacts hospital outcomes, hospitalised patients should receive proper nutritional management. Enteral nutrition (EN) is the most common route for non-volitional dietary support, usually fed four times/day. It is different from patients with volitional feeding who receive only three meals/day. This practice may affect blood glucose (BG) control in enteral feeding diabetes patients and increase nursing care's working burden. As a result, the study aimed to compare BG control and enteral feeding complications between 3 and 4 times feeding/day in hospitalised diabetes patients who require EN.
A non-blind randomised controlled trial study was conducted in 37 types two diabetes hospitalised patients who required EN in Thammasat University hospital (TUH) from April 1 to December 31, 2019. The study patients were randomised and stratified by HbA1C at <8% or ≥8% to treat three meals or four meals/day. BG was controlled based on the insulin injection protocol of TUH. The study data was collected at least five days until the patients were stopped EN or discharged from the hospital. The primary outcome was a percentage of times BG was in controlled at ≤180mg/dl. The secondary outcomes were any feeding complications such as frequency of hypoglycemia, diarrhea and gastric residual volume over 100 ml before the next feeding time.
37 patients were included. 83% of the patients were female, and the mean age was 78.44 ± 8.14 and 74.11 ± 10.03 years old in three meals and four meals feeding group, respectively. There were none significant in mean percentage of BG control between three times and four times/day either in HbA1C <8% and HbA1C ≥8% (52.21% and 68.43%, value = 0.192 and 54.29% and 55.10%, value = 0.942, respectively). Percentage of hypoglycemic events were none significant in 3 vs 4 times feeding at 1.70% vs 0.99%, value = 0.552 and 2.53% vs 2.00%, value = 0.727 in HbA1C <8% and HbA1C ≥8%, respectively. However, other complications were not significant between two groups.
There was no clinically significant outcome on BG control and other complications between three and four times feeding/day in type 2 diabetes hospitalised patients. Therefore, three times feeding can be implied in clinical practice to reduce the burden of nursing care.
由于营养不良会对医院治疗结果产生负面影响，住院患者应接受适当的营养管理。肠内营养（EN）是非自主饮食支持最常见的途径，通常每天喂食4次。这与每天只吃三餐的自主进食患者不同。这种做法可能会影响肠内营养糖尿病患者的血糖（BG）控制，并增加护理工作负担。因此，本研究旨在比较需要肠内营养的住院糖尿病患者每天3次和4次喂食时的血糖控制情况及肠内营养并发症。
2019年4月1日至12月31日，在泰国法政大学医院（TUH）对37例需要肠内营养的2型糖尿病住院患者进行了一项非盲随机对照试验研究。研究患者根据糖化血红蛋白（HbA1C）<8%或≥8%进行随机分组和分层，分别接受一日三餐或四餐喂养。根据TUH的胰岛素注射方案控制血糖。收集研究数据至少5天，直至患者停止肠内营养或出院。主要结局是血糖≤180mg/dl处于受控状态的时间百分比。次要结局是任何喂养并发症，如下低血糖频率、腹泻以及下次喂养前胃残余量超过100ml。
纳入37例患者。83%的患者为女性，三餐喂养组和四餐喂养组的平均年龄分别为78.44±8.14岁和74.11±10.03岁。在HbA1C<8%和HbA1C≥8%的患者中，每天3次和4次喂食时血糖控制的平均百分比均无显著差异（分别为52.21%和68.43%，P值=0.192；54.29%和55.10%，P值=0.942）。在HbA1C<8%和HbA1C≥8%的患者中，3次与4次喂食时低血糖事件的百分比无显著差异，分别为1.70%对0.99%，P值=0.552；2.53%对2.00%，P值=0.727。然而，两组之间的其他并发症无显著差异。
2型糖尿病住院患者每天3次和4次喂养在血糖控制和其他并发症方面没有临床显著差异。因此，在临床实践中可以采用一日三餐喂养以减轻护理负担。
