Glycemic Control During Enteral Tube Feeding in Patients with Diabetes Mellitus

Abstract

Introduction Achieving good glycemic control during enteral tube feeding in patients with diabetes mellitus can be difficult. National guidelines emphasize the need for the early involvement of the dietitian and diabetes specialist nurse, regular capillary blood glucose (CBG) monitoring, and the avoidance of hypoglycemic events. We aimed to assess glycemic control in patients with diabetes during enteral tube feeding. Materials and methods A retrospective study, involving patients with diabetes who had enteral tube feeding during their hospital stay from January to December 2016, was performed. Data included feed carbohydrate content, infusion rate and duration, involvement of dietitian and inpatient diabetes specialist nurse, capillary blood glucose monitoring, and documentation of hypoglycemic events. Results There were 40 patient episodes. Mean (range) age: 67 (29-94) years, 60% were male, 97.5% had type 2 diabetes, and 60% were on oral hypoglycemic agents prior to admission. The average feed carbohydrate content was 14.6 g/dL and the average feed rate was 73 ml/hour. Dietitians and diabetes inpatient specialist nurses (DISNs) were involved in 100% and 75% of cases, respectively. During enteral tube feeding, capillary blood glucose was controlled using metformin, subcutaneous insulin, or intravenous insulin in 30%, 42.5%, and 15% of cases, respectively. Capillary blood glucose was checked four to six hourly in 100% of cases. The target capillary blood glucose range (6-12 mmol/L) was achieved in 40% of cases. The minimum capillary blood glucose value (median (interquartile range)) was 4.9 (3.9-6.2) mmol/L and the maximum value was 15.1 (11.9-18.8) mmol/L. Using these lower and upper quartile values for minimum and maximum values, respectively, revealed that 57.5% of patients had a capillary blood glucose range of 3.9-18.8 mmol/L. Two patients had hypoglycemic events requiring treatment. Conclusions This study demonstrated that despite adequate adherence to our trust's guidelines for glycemic control during enteral tube feeding in patients with diabetes, the target glycemic range was achieved in 40% of cases. The importance of the early involvement of the diabetes inpatient specialist nurse cannot be overemphasized. Early initiation and proactive (daily) dose up-titration of insulin are required to improve glycemic control during enteral tube feeding. A national audit tool for glycemic control and mortality data during enteral tube feeding is required.

Keywords: diabetes; diabetes specialist nurse; dietitian; enteral tube feeding; glycaemic control; nutrition.

Figure 1. Graph showing glycemic control in relation to the target during enteral tube feeding for the 40 patients

The vertical bars represent each patient’s capillary blood glucose readings during enteral tube feeding (ranging from minimum to maximum) in relation to the target capillary blood glucose range (represented by horizontal bars at the 6 mmol/l and 12 mmol/l points).