Glycaemic control in insulin requiring diabetes patients receiving exclusive enteral tube feeding in an acute hospital setting

Abstract

Aims: Optimising glycaemic control for insulin requiring individuals during enteral feeding is important but difficult. We compare 3 insulin regimens with the aim of improving glucose control and reducing hypoglycaemia.

Methods: Comparison of 3 insulin/feed regimens: (1) A 20 h feed using a 30:70 premixed insulin (2) Three bolus (4 h) feeds combined with short acting analogue insulin and a basal long acting insulin. (3) A 24 h feed combined with a long acting analogue insulin. The study combined a retrospective analysis of regimen (1) with consecutive prospective analyses of (2) and (3).

Results: Glucose concentrations were suboptimal with higher values during the feeds (12.6 mmol/L ± 4.4 vs 10.3 ± 4.1 p<0.001). Although there was no overall difference in glucose control between groups there was a reduction in hypoglycaemia during the feed in the bolus group (no hypoglycaemia during intermittent feeds p<0.001).

Conclusions: Glucose concentrations were relatively high overall. Short bolus feeding appears to reduce the frequency of hypoglycaemia. This is of clinical significance for this patient group.

Keywords: Enteral feeding; Glucose variability; Glycaemic control; Hospital care; Hypoglycaemia; Insulin.