Safer glycemic control using isomaltulose-based enteral formula: a pilot randomized crossover trial

Area of Science:

• Critical care medicine
• Endocrinology
• Nutritional support

Background:

• Hyperglycemia management is crucial in critical illness but insulin therapy poses hypoglycemia risks.
• Isomaltulose-based enteral formula (IF) has shown potential for glycemic reduction in diabetic patients.
• Postoperative hyperglycemia requires effective and safe management strategies.

Purpose of the Study:

• To evaluate the efficacy of isomaltulose-based enteral formula (IF) in improving glycemic control.
• To compare IF with standard feeding formula (SF) in postoperative critically ill patients.
• To assess the safety of IF regarding hypoglycemia risk.

Main Methods:

• Randomized controlled crossover study involving eight postoperative critically ill patients with hyperglycemia.
• Patients received either IF or SF for 16 hours, followed by an 8-hour washout period and crossover.
• Continuous glucose monitoring was performed throughout the study using STG-22.

Main Results:

• Maximum blood glucose was significantly lower with IF (181 mg/dL) compared to SF (206 mg/dL) (P = .001).
• Mean glycemia during feeding was significantly reduced with IF (162 mg/dL) versus SF (176 mg/dL) (P = .0001).
• Fewer patients on IF (37.5%) exceeded 180 mg/dL compared to SF (87.5%) (P = .005), with no hypoglycemia observed.

Conclusions:

• Isomaltulose-based enteral formula (IF) demonstrates potential for safer glycemic control in postoperative critically ill patients.
• IF may be a beneficial alternative to standard formulas for managing hyperglycemia in this population.
• Further research is warranted to confirm the clinical benefits of IF feeding.