Safer glycemic control using a fructose-based enteral formula : a randomized crossover clinical trial

Abstract

Introduction: Glycemic variability during nutritional therapy in critically ill patients is associated with morbidity and mortality. A low-carbohydrate diet can be help avoid glycemic oscillation in patients under enteral nutrition; however, it is unclear whether the presence of fructose interferes with glycemic variability. Aim: Our study aimed to evaluate the effect of two diabetes-specific diets (fructose-based versus maltodextrin-based) on the glycemic variability of critically ill patients. Methods: This was a randomized, active-controlled, double-blinded crossover clinical trial comparing diabetes-specific enteral formula with fructose versus without fructose. Patients under enteral nutrition who developed hyperglycemia during their intensive care unit stay were included. Patients were randomized to receive one of two diets for 2 days before switching to the other diet. A capillary blood sample was taken every 4 h, and glycemic variability was defined as the difference between each time point. Results: Twenty-five patients completed both formulas. Patients that underwent the fructose- based diet reduced their glycemic variability by 6.30 mg/dL relative to those that received the maltodextrin-based diet (95%CI -13.86 to 1.26 mg/dL, p = 0.101 for between-group differences). This effect was seen without any complications. Conclusion: A diabetes-specific enteral formula with fructose had no difference in glycemic variability in critically ill patients versus a diabetes-specific enteral formula without fructose.