Nutritional therapy in critically ill patients with diabetes

Doola, Ra’eesa; Preiser, Jean‐Charles

doi:10.1097/mco.0000000000000807

Cited by 4 publications

(2 citation statements)

References 22 publications

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“…Those that are digestible are usually broken down into monosaccharides for energy, whereas indigestible carbohydrates produce energy through fermentation in the colon, which may impact insulin resistance through secondary metabolite production by the microbiome, such as butyrate production. Both the chemical composition and the digestibility of carbohydrates impact glycaemic control both in health and in critical illness [23,25].…”

Section: Reducing or Modifying Carbohydrate Intake In Enteral Formulamentioning

confidence: 99%

Nutrition support, carbohydrate feeding and insulin sensitivity in the critically ill patient: a complex relationship

Doola,

Dupuis,

Preiser

2024

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of review This review aims to summarize recent studies that highlight the complex relationship between nutrition, carbohydrate, insulin provision and glycaemic control in the critically ill patient population. Recent findings Results of observational studies concur to support early hypoglycaemia and persisting hyperglycaemia as life-threatening events. In contrast, interventional studies indicate that early macronutrient restriction appears to reduce the benefits related to insulin therapy. This restriction is however associated with improved outcomes in itself. The potential role of modified enteral solutions as an adjunctive treatment to attenuate hyperglycaemia warrants further research. The selection of a therapeutic modality may also differ according to the characteristics of the setting, such as the nurse-to-patient ratio, the type and accuracy of meters, including near-continuous glucose monitoring and the availability of computer-guided protocols. Summary There appears to be significant interplay between nutrition, including carbohydrate provision, blood glucose control and clinical outcomes. Individualized care is probably needed to define the optimal glucose target and nutritional intervention. This can differ according to the preexistence of chronic hyperglycaemia, the timing from the onset of critical illness and the clinical condition itself.

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Section: Reducing or Modifying Carbohydrate Intake In Enteral Formulamentioning

confidence: 99%

Nutrition support, carbohydrate feeding and insulin sensitivity in the critically ill patient: a complex relationship

Doola,

Dupuis,

Preiser

2024

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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“…Given the associated cardiovascular autonomic neuropathy and hypoglycemia unawareness that is prevalent in this cohort, such hypoglycemic episodes are potentially harmful. If these data are representative of care provided in other hospitals, it should encourage the use of greater monitoring of blood glucose on discharge to the ward, and consideration of using alternatives to insulin to lower blood glucose without the risk of hypoglycemia [40], and a greater focus on matching nutritional therapy to the needs of the patient [42,43].…”

Section: Updates For Glucose Monitoring After Intensive Care Unit Dis...mentioning

confidence: 99%

Update on glucose control during and after critical illness

Deane

Plummer

Abdelhamid

2022

Current Opinion in Critical Care

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Purpose of reviewThere is a complex bidirectional relationship between critical illness and disordered glucose metabolism. This review aims to provide a comprehensive summary of the recent evidence focused on the relationship between critical illness and disordered glucose metabolism through the distinct phases of prior to, during, and after an acute illness that requires admission to the intensive care unit (ICU).Recent findingsRecent data suggest that preexisting glucose metabolism affects the optimal blood glucose target during critical illness, with preliminary data suggesting that glucose targets should be ‘personalized’ based on preexisting glycemia. Because of the close association between critical illness and disordered glucose metabolism, there is a need to optimize glucose monitoring in the ICU with rapid, precise, and cost-efficient measurements at the bedside. Recent studies have evaluated the use of various methodologies, with a focus on the use of near-continuous glucose monitoring. For those patients with preexisting diabetes who survive ICU, nocturnal hypoglycemia may be an unrecognized and important issue when discharged to the ward. There is increasing evidence that patients with high blood glucose during their acute illness, so called ‘stress hyperglycemia’, are at increased risk of developing diabetes in the years following recovery from the inciting event. Critically ill patients with COVID-19 appear at greater risk.SummaryThere have been important recent insights in the approach to glucose monitoring and glucose targets during critical illness, monitoring and administration of glucose-lowering drugs on discharge from the ICU, and longitudinal follow-up of patients with stress hyperglycemia.

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