Evidence-based recommendations and expert consensus on enteral nutrition in the adult patient with diabetes mellitus or hyperglycemia

Abstract Objective The aim of this study was to develop evidence-based recommendations for glycemic control of patients with diabetes mellitus or stress hyperglycemia who are receiving enteral nutrition (EN). Methods A Delphi survey method using Grading Recommendations Assessment, Development and Evaluation criteria was utilized for evaluation of suitable studies. Results In patients with diabetes or stress hyperglycemia who were on EN support, the following results were found: 1. Apply the same goals of metabolic control as applied for all diabetic patients; 2. The caloric intake provided by EN should be similar to that of patients without diabetes and with the same clinical condition; 3. Determine the percentage of macronutrients based on an individualized assessment of metabolic goals and comorbidities; 4. Diabetes-specific EN formulas should contain low-glycemic index carbohydrates and a moderate or high percentage of monounsaturated fatty acids in relation to the total caloric value; 5. Specific formulas for diabetes should contain fiber, although its presence is not a determining factor for reduction of postprandial glycemia; 6. Diabetes-specific rather than standard hyperproteic formulas in mechanically ventilated patients in the intensive care unit should be used as these formulas not only improve metabolic control, they also may reduce complications from respiratory infections; 7. Diabetes-specific formulas should be used for home EN; 8. Insulin therapy with basal-bolus regimens should be used for hospitalized patients with hyperglycemia and enteral feeding; and 9. Postpyloric route for patients with diabetic gastroparesis requiring enteral feeding is strongly recommended. Benefits of supplementation with vitamins/minerals above standard requirements remain unclear. Conclusions These recommendations and suggestions regarding enteral feeding in patients with diabetes and hyperglycemia have direct clinical applicability.