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Change in blood glucose and insulin concentrations from baseline over time among patients receiving experimental and control formula (N = 12). Change in a blood glucose (mmol/l) and b insulin (?IU/ml) concentrations from baseline over time (minutes) post infusion by formula are shown. The experimental (E) formula is shown in blue, and the control (C) formula is shown in red. Bars represent standard error of the mean. The p-values for testing if blood glucose concentration was different from baseline at each time point within formulas (from 0' (C)* and from 0' (E)*, *: statistical significances were observed at a modified alpha-level of 0.005 with the Bonferroni correction) and for testing if blood glucose concentrations were different between the two formulas (E vs C) at each time point are shown on the top of the plot
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Background and objectives:
Standard enteral nutrition (EN) formulas can worsen hyperglycemia in diabetic patients. We hypothesized that altering the proportion of macronutrients in a formula; increasing protein while decreasing carbohydrate concentrations would improve glycemic response. The objective of this study was to demonstrate that an EN fo...
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Context 1
... change in glucose concentrations from baseline over 240 min for each formula are illustrated in Fig. 1a. The mean blood glucose concentrations for the experimental and the control formulas were 7.58 ? 2.09 and 7.20 ? 1.66 mmol/l, respectively, and were compar- able at baseline (p = 0.48). Compared to the baseline (0 min), there was a significant increase in blood glucose concentrations within 10 min in response to a dietary challenge with the control formula (adjusted p < 0.005), which lasted until 150 min. In contrast, only moderate increases in blood glucose concentrations from baseline occurred at 30 min with experimental formula (adjusted p = 0.009), with no further increase in blood glucose across time. Between the formulas, the increase in blood glucose was significantly lower when the subjects were given the experimental formula compared to the control formula across eight time points from 10 to 180 min (p < 0.05). Blood glucose returned to the baseline level at 180 min with control formula (adjusted p > 0.1), and were no longer significantly different between the two formulas at 210 and 240 min (p > 0.05). The minimum and maximum of the mean glucose concentrations (mmol/l) for the experimental formula were smaller than those of the control formulas over the course of the trial [(6.48 ? 2.41, 9.00 ? 1.71) and (6.90 ? 2.79, 10.78 ? 2.47), respectively]. The AUCs for glucose are shown for each subject in Table 3. The mean AUC for glucose for the experi- mental formula was smaller than that of the control for- mula (71.99 ? 595.18 and 452.62 ? 351.38, respectively; p = 0.03). Individual AUCs were smaller in 11 of 12 subjects receiving the experimental rather than for the control formula (Table 3, AUC: Control-AUC: Experi- mental) as expected. Peak blood glucose concentration (C max ) and time of C max (T max ) are also shown in Table 3. The peak glucose concentrations of the experimental formula were con- sistently lower than those of the control formula for all subjects (Table 3, C max : Control-C max : Experimental). The time to achieve the highest glucose value (T max ) varied between subjects with some achieving their highest values within 10 min and others up to 150 min. Interest- ingly, the formulas also influenced the T max with some subjects achieving T max that were widely different between formulas. Overall, T max for the experimental group occurred at 66.7 ? 43.6 min as compared to 70.8 ? 43.6 min (p = 0.78) in the control ...
Context 2
... change in insulin concentration from baseline over 240 min by formulas are shown in Fig. 1b and are char- acterized by significant variations between individuals. The mean insulin concentrations were not statistically different at baseline between the formulas (11.4 ? 7.2 and 9.2 ? 6.8 ?IU/ml for experimental and control, respec- tively; p = 0.23). There was a trend towards lower average endogenous insulin production in response to the experimental group over time (10-240 min) when com- pared to the control group (p > 0.1). The minimum and maximum of the mean insulin (?IU/ml) for the experi- mental and the control formulas were (11.4 ? 7.2, 34.9 ? 26.0) and (9.2 ? 6.8, 64.2 ? 81.6), respectively. The mean insulinogenic indices for the experimental and the control formulas were 10.9 ? 12 and 6.6 ? 10.4, and the mean first-phase insulin measures (AUC 0-30 min) were 244.6 ? 227.6 and 521.5 ? 749.3, respectively. There were no significant difference between the formulas for these outcomes (p = 0.15; p = 0.23, respectively; data not ...
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Citations
... Permana (2015) revealed a strong connection between religious beliefs and cultural values among Muslim Javanese. [95], religious engagement and emotional support from family have a big impact on the participant's knowledge and abilities in diabetes treatment. Islamic self-surrender practice contains several activities such as breathing techniques, guided imagery, and recurrent prayers which objectively manage non-psychotic depression and anxiety in chronic illness patients [17]. ...
This study aims to investigate the impact of an Islamic-based self-resignation exercise accompanied by natural volunteer assistance on the knowledge, control, self-management, and quality of life of Type 2 Diabetes Mellitus (T2DM) patients who also experience depression. The research method adopted a mixed methods design integrating quantitative experimental research with qualitative descriptive analysis. The findings showed that age and education had a significant effect on self-management, while income and T2DM duration had no partial effect on these aspects. The assistance of natural volunteers in Islamic-based self-surrender exercises positively strengthens the influence of patients' knowledge and self-management on T2DM control. The practical implications of these findings highlight that surrender exercises and the involvement of natural volunteers can be effective and culturally appropriate modalities to improve the knowledge, self-management behaviors, and quality of life of T2DM patients, especially for those who also experience depression. This study makes a valuable contribution to health practitioners and researchers interested in holistic approaches to chronic disease management.
... Diabetes Mellitus (DM) is one of the fastest-growing chronic diseases with a prevalence increasing in an epidemic worldwide (Huhmann et al., 2018;Sørensen, 2022). Intensive care (ICU) sometimes will be required for patients with diabetes mellitus who are in critical condition or DM that progresses to severe acute disease (Kar, 2015). ...
... Also, using the same standard enteral formula for days will raise the patient's blood glucose because it is low in fiber and high in sugar content. Therefore diabetes-specific enteral formulas are recommended (Elia, 2005;Mabrey et al., 2015;Huhmann et al., 2018;Wijayanti et al., 2020). ...
... Formula B had the highest density, and this is because formula B had the highest fat percentage among other formulas. in the standard range has improved glucose control by reducing mean glucose and significantly lowering insulin requirements compared with standard feeding in patients with diabetes (Huhmann et al., 2018). This improvement is associated with reduced insulin requirements due to the small number of carbohydrates given to the patient (Mesejo et al., 2015). ...
The diabetes-specific enteral formula is necessary to assist glycemic control for critically ill diabetic patients. The GLITEROS enteral formula is an innovative diabetes-specific hospital enteral formula made from local food, jicama flour and tempeh flour. However, the fat content in the GLITEROS enteral formula does not meet the fat requirements for a diabetes-specific enteral formula. Sunflower seeds are a good food source of monounsaturated fatty acids, specifically oleic acid which has antidiabetic effects. The addition of sunflower seeds to the GLITEROS enteral formula as a modification can optimize the lack of fat content. This study aimed to analyze the macronutrient content, dietary fiber, protein digestibility, and physical properties, including viscosity and osmolality of the modified GLITEROS enteral formula. This research was an experimental study with four formula groups, Formula A, B, C, and D, with different ratios of tempeh flour, jicama flour, and sunflower seed flour; (1:1:1), (1:1:2), (1:2:1), and (2:1:1). The variables of this study were energy density, calories, carbohydrates, fat, protein, dietary fiber, protein digestibility, viscosity, and osmolality were tested with three repetitions in duplicate. Data analysis used One-way ANOVA and the Kruskal-Wallis test. Formula B had the highest density of energy, energy, fat, and dietary fiber compared to the four formulas. Meanwhile, Formula C had the highest protein content and digestibility value compared to other formulas. The highest viscosity and osmolality values were in formula A. Formula C was the most qualified formula in terms of macronutrient content, dietary fiber, protein digestibility, and physical properties of diabetes-specific enteral formulas according to the requirements of the American Diabetes Association (ADA), Canadian Diabetes Association (CDA), American Society of Parenteral and Enteral Nutrition (ASPEN)
... The American Society for Parenteral and Enteral Nutrition (ASPEN) guidelines recommends enteral versus parenteral nutrition in patients with a functioning digestive tract because it reduces infection morbidity and length of hospital stay (Lewis et al. 2016;Ma et al. 2020). While the administration of standard enteral formulas has been reported to exacerbate hyperglycemia in critically ill patients with diabetes (Huhmann et al. 2018). This condition is because the standard enteral formula usually given has a composition of low fat, low fiber, and high simple carbohydrates which are quickly absorbed so that it can exacerbate hyperglycemia if given continuously (Elia et al. 2005;Mabrey et al. 2015). ...
Tempeh, yam, and sunflower's flour have been known to have antidiabetic effects, but their combined effect on the histopathology of hyperglycemic rat pancreatic cells in an enteral formula has not been proven. This study aimed to analyze the effect of GLITEROS specific-diabetes enteral formula modification based on tempeh flour, yam flour, and sunflower seed flour on the score pancreatic damage, number and diameter of the islets of langerhans of hyperglycemic rats with streptozotocin induction. The intervention was administered via an oral probe for 28 days to 30 Wistar rats, with each group consisting of 6 rats. The formula was given at a dose of 3.97 g/200 g/day (P1) and 8.75 g/200gr/day (P2) compared to standard control (K), positive control (K +), and negative control (K-). Histopathological features of the pancreas were analyzed using the hematoxylin–eosin staining method. Data were analyzed using paied t-test/Wilcoxon and ANOVA/Kruskal Wallis. The results showed a significant repair of pancreatic cell damage in the treatment group (P1 and P2) after the intervention ( p < 0.05), but there was no difference in the number and diameter of the islets of Langerhans ( p > 0.05). Overall, our findings suggest that the modified GLITEROS specific-diabetes enteral formula made from tempeh, yam, and sunflower seeds flour on the histopathological picture of hyperglycemia-induced rat pancreas, especially in the repair of damage to pancreatic Langerhans cells.
Graphical Abstract
... However, whey protein supplementation was not effective [43]. Vitamin D supplementation did not affect type 2 diabetes incidence or insulin resistance [44]. ...
Background: The prevalence of type 2 diabetes is a global health challenge that requires continuous care. Non-pharmaceutical interventions in controlling and treating type 2 diabetes can be less costly and have fewer complications. Accordingly, this study identifies non-pharmaceutical interventions in controlling and treating type 2 diabetes through systematic review. Methods: This study is a systematic review of the papers published in non-pharmaceutical interventions to control and treat type 2 diabetes. The authors have used the standard guideline of systematic review (PRISMA). A total of 41 papers were selected from 529 full-text articles published between 2014 and 2020. The search included the electronic data banks, including Medline, Science Direct, Embase, Scopus, Cochrane Library, and the Google Scholar search engine. Results: Non-pharmaceutical interventions were classified into four categories: Lifestyle, treatment devices, traditional treatment, and education. The results showed that lifestyle modification is the most effective non-pharmaceutical intervention for treating type 2 diabetes. Conclusion: Study findings show that applying non-pharmaceutical interventions effectively controls and prevents type-2 diabetes complications. Education is a part that needs to be given more attention.
... This means that if patients are fed exclusively by enteral nutrition, they usually receive 250-270 g of CHOs, 75-100 g of protein and 65-77 g of lipids providing a total of 2000 kcal per day. In patients with type 2 diabetes who receive a special diabetic enteral diet, the intake of CHOs is even lower [8]. If patients need more energy supply, this is usually given in the form of fat. ...
Carbohydrate (CHO) intake in oral and enteral nutrition is regularly reduced in nutritional support of older patients due to the high prevalence of diabetes (usually type 2—T2DM) in this age group. However, CHO shortage can lead to the lack of building blocks necessary for tissue regeneration and other anabolic processes. Moreover, low CHO intake decreases CHO oxidation and can increase insulin resistance. The aim of our current study was to determine the extent to which an increased intake of a rapidly digestible carbohydrate—maltodextrin—affects blood glucose levels monitored continuously for one week in patients with and without T2DM. Twenty-one patients (14 T2DM and seven without diabetes) were studied for two weeks. During the first week, patients with T2DM received standard diabetic nutrition (250 g CHO per day) and patients without diabetes received a standard diet (350 g of CHO per day). During the second week, the daily CHO intake was increased to 400 in T2DM and 500 g in nondiabetic patients by addition of 150 g maltodextrin divided into three equal doses of 50 g and given immediately after the main meal. Plasma glucose level was monitored continually with the help of a subcutaneous sensor during both weeks. The increased CHO intake led to transient postprandial increase of glucose levels in T2DM patients. This rise was more manifest during the first three days of CHO intake, and then the postprandial peak hyperglycemia was blunted. During the night’s fasting period, the glucose levels were not influenced by maltodextrin. Supplementation of additional CHO did not influence the percentual range of high glucose level and decreased a risk of hypoglycaemia. No change in T2DM treatment was indicated. The results confirm our assumption that increased CHO intake as an alternative to CHO restriction in type 2 diabetic patients during oral and enteral nutritional support is safe.
... Many large studies proved that hyperglycemia and DM may deteriorate the progression and severity of COVID-19 and associate with poorer prognosis and high mortality in suffered patients (4)(5)(6). Many studies proved that commercial food suitable for diabetic patients was mostly lower in carbohydrates than the controlling food (7). The use of diabetes-specific nutrition formula (DSNF) has consistently been shown to improve postprandial glucose levels compared to standard test foods such as oatmeal of similar caloric content (8). ...
... Fórmula nutricional específica para diabetes: Una fórmula EN que contiene cargas altas en proteínas y bajas en carbohidratos puede mejorar significativamente el control de la glucosa en sujetos con diabetes tipo 2 en entornos ambulatorios, como lo demuestra el control mejorado de la glucosa observado sin una diferencia significativa en la respuesta a la insulina (79). ...
La diabetes mellitus tipo 2 constituye una condición clínica debilitante, degenerativa y multifacética de alta prevalencia a nivel mundial. Dada la complejidad de su fisiopatología y las variadas opciones terapéuticas que existen esta enfermedad presenta un desafío para el médico general, se hace imperativo describir comprensiblemente esta patología para mejorar la resolutividad de ésta en atención primaria. Tras una búsqueda bibliográfica exhaustiva de 103 estudios publicados hasta el año 2010, se identificaron los aspectos más importantes tanto de la fisiología, fisiopatología, complicaciones y terapéuticas de esta patología. La resistencia a la insulina (RI) es una condición metabólica central en la etiopatogenia de esta patología donde se logra reconocer de manera clásica tanto la pérdida de la acción periférica de la insulina por parte de los diferentes tejidos, así como defectos en la secreción de insulina conllevando estados de hiperglucemia constantes asociados tanto a complicaciones agudas como crónicas caracterizadas por provocar disfunción y fallo en diferentes órganos. Es de conocimiento general que parte importante de los resultados en el manejo de esta patología se logran con cambios en el estilo de vida que van desde modificaciones en la dieta a cambios en el patrón de actividad física con pérdida de peso corporal. No obstante, existe a su vez una amplia gama de terapias farmacológicas orientadas a controlar estados hiperglucémicos ante la falla de la terapia no farmacológica. Dentro de este mismo contexto varias son las dianas y objetivos terapéuticos en el tratamiento del diabético tipo 2, sin embargo, todas confluyen en el control metabólico de los estados de hiperglucemia y la prevención de sus complicaciones.
... One explanation for greater insulin administration with Nutrison Protein Plus is that the other formulae are considered to be 'low glycaemic index' formulae and, in health, the administration of these 'low glycaemic index' formulae slows gastric emptying, which attenuates glycaemic excursions and reduces insulin requirements. 22,23 However, because gastric emptying is already delayed during critical illness, 24 the effect of drugs that have a potent effect to slow gastric emptying, such as glucagonlike peptide-1 (GLP-1), is diminished in this population. 25 Accordingly, it is unlikely that the effect of the formula on gastric emptying entirely explains our observations. ...
Background:
Hyperglycaemia occurs frequently in the critically ill. Dietary intake of advanced glycation end-products (AGEs), specifically Nε-(carboxymethyl)lysine (CML), may exacerbate hyperglycaemia through perturbation of insulin sensitivity. The present study aimed to determine whether the use of nutritional formulae, with varying AGE loads, affects the amount of insulin administered and inflammation.
Methods:
Exclusively tube fed patients (n = 35) were randomised to receive Nutrison Protein Plus Multifibre®, Diason® or Glucerna Select®. Insulin administration was standardised according to protocol based on blood glucose (<10 mmol L-1 ). Samples were obtained at randomisation and 48 h later. AGEs in nutritional formula, plasma and urine were measured using mass spectrometry. Plasma inflammatory markers were measured using an enzyme-linked immunosorbent assay and multiplex bead-based assays.
Results:
AGE concentrations of CML in nutritional formulae were greatest with delivery of Nutrison Protein Plus® (mean [SD]; 6335 pmol mol-1 [2436]) compared to Diason® (4836 pmol mol-1 [1849]) and Glucerna Select® (4493 pmol mol-1 [1829 pmol mol-1 ]) despite patients receiving similar amounts of energy (median [interquartile range]; 12 MJ [8.2-13.7 MJ], 11.5 MJ [8.3-14.5 MJ], 11.5 MJ [8.3-14.5 MJ]). More insulin was administered with Nutrison Protein Plus® (2.47 units h-1 [95% confidence interval (CI) = 1.57-3.37 units h-1 ]) compared to Diason® (1.06 units h-1 [95% CI = 0.24-1.89 units h-1 ]) or Glucerna Select® (1.11 units h-1 [95% CI = 0.25-1.97 units h-1 ]; p = 0.04). Blood glucose concentrations were similar. There were associations between greater insulin administration and reductions in circulating interleukin-6 (r = -0.46, p < 0.01), tumour necrosis factor-α (r = -0.44, p < 0.05), high sensitivity C-reactive protein (r = -0.42, p < 0.05) and soluble receptor for advanced glycation end-products (r = -0.45, p < 0.01) concentrations.
Conclusions:
The administration of greater AGE load in nutritional formula potentially increases the amount of insulin required to maintain blood glucose within a normal range during critical illness. There was an inverse relationship between exogenous insulin and plasma inflammatory markers.
... The importance of nutritional adjustments in the alleviation of T2DM by influencing weight and regulating metabolism has also been studied (3,4). In addition, modifying carbohydrate and protein composition, adding monounsaturated fatty acids (MUFA), polyunsaturated fatty acids (PUFA), dietary fiber, and various vitamins and minerals have shown improved blood sugar, lipid, and protein metabolism comparing with a standard diet (5)(6)(7). ...
... Soluble dietary fiber significantly improved postprandial BLG control by delaying glucose absorption in the small intestine (11)(12)(13). A very high-protein and low-carbohydrate oral nutrition formula (protein provided 37% of total calories and carbohydrate provided 35% of total calories) also improved BLG with no significant statistical difference in insulin responses on T2DM (5). ...
... Dietary protein influences lipid, protein, and glucose metabolism (8). SP could lower cholesterol levels in animals and humans with unclear mechanisms (5,9). Moriyama et al. suggested that the soybean β-conglycinin diet could reduce serum TG and glucose in genetically obese mice (37). ...
Oral nutritional (ON) products are an effective way to treat patients with type 2 diabetes mellitus (T2DM) whose gastrointestinal functions are normal. The influence of ON formula prepared with three different proteins on T2DM was studied. The hyperglycaemic mouse model using a high-fat diet (HFD) combined with an intraperitoneal injection of streptozotocin (STZ) was used to simulate T2DM. The study was done for 15 weeks using seven groups of mice: control group (CG, normal mice, and normal food), non-treated group (BG, diabetic mice, and normal food), positive control group (PG, diabetic mice, and HFD), soybean protein group (SPG, diabetic mice, and HFD), silkworm pupa protein group (SPPG, diabetic mice, and HFD), whey protein group (LPG, diabetic mice, and HFD), and whey protein combined with silkworm pupa protein group (LCSSPG, diabetic mice, and HFD). The plasma levels of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were analyzed on weeks 2, 10, 12, 14, and 15. The concentration of total protein (TP) and albumin (ALB) of the plasma was increased in SPG, SPPG, and PG comparing with BG (p < 0.05). The TC, TG, and LDL-C levels were decreased, and HDL-C level was increased in SPG, PG, SPPG, PG comparing with BG (p < 0.05). Blood glucose (BLG) levels were decreased 47, 34, 24, and 21% in SPG, LCSSPG, SPPG, and PG, respectively. While BLG was not significantly changed (p ≥ 0.05) in LG after 5 weeks of treatment. Overall, the data suggested that consumption of SP, SPP, LCSSPG Oral-formula may be beneficial for the treatment of T2DM.
... Indeks glikemik yang terkontrol sangat berpengaruh dalam proses penyembuhan luka DFU. 24 Karbohidrat untuk penderita diabetes yang aman dikonsumsi adalah sekitar 45-60 gram per kali makan, atau sebesar 135-180 gram karbohidrat per hari. Selain nasi, sagu, dan jagung, karbohidrat dapat diperoleh dari makanan bertepung, seperti pasta, roti dan olahan pati. ...
Latar belakang: Asupan gizi merupakan salah satu faktor yang berperan penting dalam proses penyembuhan luka, khususnya Diabetic Foot Ulcer (DFU). Oleh karena itu, selain merawat kaki, pasien DFU sangat dianjurkan untuk memperhatikan diet dan gizi yang dikonsumsi.Tujuan: Penelitian ini bertujuan untuk mereview peran gizi pada proses penyembuhan DFU.Metode: Metode yang digunakan dalam penelitian ini adalah literature review yaitu mengkaji secara kritis temuan-temuan yang telah dipublikasikan sebelumnya. Artikel dari 3 database, yaitu SCOPUS, PubMed, dan Google Scholar yang sesuai dengan kriteria inklusi kemudian dianalisis untuk menjawab tujuan penelitian. Kriteria inklusi artikel yang disertakan dalan penelitian meliputi artikel yang telah dipublikasikan pada jurnal internasional dengan rentang publikasi dari Januari 2015 sampai Desember 2019, berupa Randomized Controlled Trial (RCT), dan berbentuk full-text. Enam artikel dianalisis dan disintesis untuk mendapatkan hasil penelitian berdasarkan proses skrining, seleksi, dan pemilihan artikel.Hasil: Literature review ini menunjukkan bahwa gizi, baik dalam bentuk macronutrient (misalnya omega 3) maupun micronutrient (seng, magnesium, vitamin D, vitamin E, dan probiotik), berperan penting dalam proses penyembuhan luka DFU. Macro dan micronutrient ini berperan mulai dari proses modulasi proliferasi sel, metabolisme kolagen, serta sebagai biomarker fase inflamasi dan oksidasi. Asupan gizi yang tepat akan mengontrol dan menekan komplikasi DFU sehingga penyembuhan lukanya berjalan secara optimal. Omega-3, seng, magnesium, vitamin D, vitamin E, dan probiotik berperan besar dalam peningkatan produksi kolagen, sintesis protein, dan pembuangan bakteri serta sel - sel nekrotik.Simpulan: Baik macronutrient maupun micronutrient, keduanya dibutuhkan di dalam tubuh untuk mendukung proses penyembuhan luka DFU. Masing-masing komponen tersebut mempunyai peran penting dalam proses penyembuhan luka.
