Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
Centro de Investigación en Endocrinología y Nutrición (IENVA), Universidad de Valladolid, Valladolid, Spain.
Nutr Diabetes. 2024 May 30;14(1):34. doi: 10.1038/s41387-024-00292-4.
BACKGROUND/OBJECTIVES: In patients with acute stroke, the presence of hyperglycaemia has been associated with higher morbidity and less neurological recovery. The aim of the study was to evaluate the impact of a diabetes specific enteral nutrition (EN) formula on glycaemia, comorbidities and mortality in patients admitted with a first episode of stroke who received complete EN.
This was a prospective randomised controlled trial. Patients with acute stroke did not have diagnosis of diabetes mellitus and required nasogastric tube feeding. This study has been registered with code NCT03422900. The patients were randomised into two arms: an isocaloric isoprotein formula (control group (CG), 27 patients) vs a diabetes-specific formula (low glycaemic index carbohydrates, fibre (80% soluble) and higher lipid content) (experimental group (EG), 25 patients). Pre-EN blood glucose, hyperglycaemia during EN treatment, HbA1c, insulin use, oral route recovery, length of stay (LOS) and mortality at 30 days were collected. The complications of enteral nutrition during admission were collected as well.
52 patients were included, 50% females, with an age of 77.44(11.48) years; 34 (65.4%) had ischaemic stroke, with a Rankin score of 0(0-2), and a National Institute of Health Stroke Scale (NIHSS) of 19 (15-22). In CG, there were more cases of hyperglycaemia on the 5th day post-NE (13(65%) vs7(35%), p < 0.01). CG showed an OR of 7.58(1.49-39.16) (p = 0.02) for the development of hyperglycaemia. There were no differences in LOS between groups (12(8.5) days vs 14(23) days, p = 0.19) or in the death rate (10(37%) vs 10(40%), p = 0.8), although differences were found in terms of oral route recovery (EG: 11(44%) patients vs CG: 5(18.5%) patients, p = 0.04) (OR (EG): 5.53(1.25-24.47); p = 0.02).
The use of a diabetes-specific enteral formula in non-diabetic patients admitted with acute stroke reduced the risk of developing hyperglycaemia and improved the rate of oral route recovery. Registered under ClinicalTrials.gov Identifier no. NCT03422900.
背景/目的：在急性脑卒中患者中，高血糖与更高的发病率和更少的神经恢复有关。本研究的目的是评估在接受首次卒中发作并接受完全肠内营养（EN）的患者中，使用特定于糖尿病的肠内营养配方对血糖、合并症和死亡率的影响。
这是一项前瞻性随机对照试验。患有急性脑卒中的患者没有糖尿病的诊断，需要经鼻胃管喂养。本研究已在 NCT03422900 注册。患者被随机分为两组：等热量等蛋白配方（对照组（CG），27 例）与特定于糖尿病的配方（低血糖指数碳水化合物、纤维（80%可溶性）和更高的脂质含量）（实验组（EG），25 例）。收集 EN 治疗前的血糖、EN 治疗期间的高血糖、HbA1c、胰岛素使用、口服途径恢复、住院时间（LOS）和 30 天死亡率。还收集了入院期间肠内营养的并发症。
52 例患者入选，女性占 50%，年龄为 77.44(11.48)岁；34 例（65.4%）为缺血性脑卒中，Rankin 评分为 0（0-2），NIHSS 评分为 19（15-22）。在 CG 组，第 5 天的高血糖发生率更高（13（65%）比 7（35%），p<0.01）。CG 组发生高血糖的 OR 为 7.58（1.49-39.16）（p=0.02）。两组 LOS 无差异（12（8.5）天比 14（23）天，p=0.19）或死亡率差异（10（37%）比 10（40%），p=0.8），尽管在口服途径恢复方面存在差异（EG：11（44%）例患者比 CG：5（18.5%）例患者，p=0.04）（OR（EG）：5.53（1.25-24.47）；p=0.02）。
在因急性脑卒中入院的非糖尿病患者中使用特定于糖尿病的肠内配方可降低发生高血糖的风险，并提高口服途径恢复的速度。在 ClinicalTrials.gov 标识符下注册 NCT03422900。
Zotero 插件