Abstract

Author(s): Sperafico Batista, Marta1; Iraci Rabito, Estela2; Michielin Busnello, Fernanda1

Introduction: According to random studies that evaluate insulin therapy and nutritional therapy in critically ill patients, glycemic control is related to the decreasing of mortality. There are only a few studies that address effective strategies in enteral nutritional therapy for glycemic control. Knowing that ENT is a factor that influences the glycemic control in critically ill patients, the diet actually offered to the patient can be evaluated as a potentiator for positive or negative effects on blood glucose.

Objective: Evaluate the glycemic control and its relation with the supply of enteral nutrition for patients admitted to an Intensive Care Unit.

Methods: A cohort historic study of 201 patients admitted to an ICU in Southern Brazil, from January to December of 2014, who received enteral nutrition for at least 72 hours after admission. Data from electronic medical records were extracted. To evaluate the glycemic control, blood glucose data were collected at the admission, 24 hours after the beginning of the treatment and one week after the diet’s initiation. Diabetic and non-diabetic patients were separated in two groups. The patients’ nutritional status was classified by the BMI (n = 76). The adequacy of the diet was evaluated as a percentage. The type of diet was classified according to the characteristics of the formulas. The patient’s time in ICU and their clinical outcome were also evaluated.

Results: The patients’ average age was 63.6 years (± 15,4), most of them were men (55.7%). Diabetics were 27.4% of the population. An average reduction of 18.4 mg/dL in blood glucose after a week of diet was observed in the group of diabetic patients but it was not significant (p = 0.075). The diet adequacy percentage was similar in both groups, for both total energy (97.2% ± 20.5) and protein (84.3% ± 23.1). The average time that patients stayed in the ICU was 17 days. This period was a little longer for diabetic patients (21 days), but it’s not a significant difference. In the non-diabetic group, glucose levels one week after the initiation of the diet were significantly higher in patients who died, compared to the ones that left the intensive care unit (p = 0.033). There were no significant associations with blood glucose and BMI, adequate energy percentage and protein, ICU time, type of diet and use of protein modules, for both the diabetic and non-diabetic groups (p> 0.10).

Discussion: Blood glucose tends to further reduce in those patients submitted to ENT with low carbohydrate formulas. The glycemic control relates to the clinical advancements in critically ill patients, providing longer survivability in patients with safe blood glucose levels.

Conclusions: The glycemic control in patients admitted to an ICU tends to be effective after a week of ENT in diabetic patients and the hyperglycemia, after a week of ENT, increases the prevalence of deaths in non-diabetic patients.