Refaat A. Hegazi

A Diabetes-Specific Enteral Formula Improves Glycemic Variability in Patients with Type 2 Diabetes

BACKGROUND Well-controlled studies have demonstrated that inpatient hyperglycemia is an indicator of poor clinical outcomes, but the use of diabetes-specific enteral formulas in hospitalized patients remains a topic of great debate. METHODS In two different protocols, postprandial glycemia and insulinemia were measured in 22 subjects with diabetes fed a diabetes-specific or standard formula (protocol 1). Continuous glucose monitoring was used to assess glucose levels in 12 enterally fed patients with diabetes receiving the standard formula followed by the diabetes-specific formula continuously for 5 days each (protocol 2). End points included postprandial glycemia and insulinemia, glycemic variability (mean amplitude of glycemic excursions [MAGE]), mean glucose, and insulin use. RESULTS In the postprandial response protocol, the diabetes-specific formula resulted in lower positive areas under the postprandial curve (P < 0.001) and peak glucose (P < 0.001) and insulin (P = 0.017) levels. In the protocol using continuous glucose monitoring, glycemic variability (as measured by MAGE) was lower with continuous administration of the diabetes-specific than the standard formula (64.6 +/- 6.8 mg/dL vs. 110.6 +/-15.3 mg/dL, P = 0.003). Also, administration of the diabetes-specific formula resulted in lower mean glucose concentrations during feeding (171.1 +/- 16.1 vs. 202.1 +/- 17.4 mg/dL, P = 0.024) and insulin requirements (7.8 +/- 2.3 vs. 10.9 +/- 3.3 units/day, P = 0.039) than the standard formula. CONCLUSIONS Relative to the standard formula, the diabetes-specific formula reduced postprandial glycemia, mean glucose, glycemic variability, and short-acting insulin requirements. These results suggest potential clinical usefulness of a diabetes-specific enteral formula for minimizing glycemic excursions in hospitalized patients.

Preoperative Standard Oral Nutrition Supplements vs Immunonutrition: Results of a Systematic Review and Meta-Analysis

Multiple studies and meta-analyses have suggested some benefit to immunonutrition (IN) supplements. These studies have often included preand post-operative regimens and have utilized inconsistent controls ranging from standard non-supplemented oral diets to high-quality isonitrogenous controls. This study aims to compare outcomes after preoperative nutritional supplementation with IN vs. standard oral nutritional supplements (ONS) or a regular diet without supplements. We performed a systematic literature review. 8 randomized controlled trials (RCTs) of preoperative IN vs. ONS were identified and 9 RCTs of IN vs. no supplements were also identified. Meta-analysis was performed for reported outcomes including wound infection, infectious and non-infectious complications, and length of stay (LOS). The meta-analysis was prepared in accordance with Preferred Reporting of Systematic Reviews and Meta-Analyses (PRISMA) recommendations. We identified 561 patients in 8 RCTs of preoperative IN vs. ONS. 895 patients were identified in 9 RCTs of IN vs. no supplements. When compared to ONS, preoperative IN was not associated with reduced wound infection (OR 0.97, 95% Confidence Interval (CI) 0.45 to 2.11), all infectious complications (OR 0.71, 95% CI 0.30 to 1.68), non-infectious complications (OR 1.25, 95% CI 0.64 to 2.43), or LOS (mean difference 0.07 days, 95% CI 2.29 to 2.43). In RCTs controlled with non-supplemented standard diets, preoperative IN was associated with decreased infectious complications (OR

Diabetes-Specific Nutrition Algorithm: A Transcultural Program to Optimize Diabetes and Prediabetes Care

Type 2 diabetes (T2D) and prediabetes have a major global impact through high disease prevalence, significant downstream pathophysiologic effects, and enormous financial liabilities. To mitigate this disease burden, interventions of proven effectiveness must be used. Evidence shows that nutrition therapy improves glycemic control and reduces the risks of diabetes and its complications. Accordingly, diabetes-specific nutrition therapy should be incorporated into comprehensive patient management programs. Evidence-based recommendations for healthy lifestyles that include healthy eating can be found in clinical practice guidelines (CPGs) from professional medical organizations. To enable broad implementation of these guidelines, recommendations must be reconstructed to account for cultural differences in lifestyle, food availability, and genetic factors. To begin, published CPGs and relevant medical literature were reviewed and evidence ratings applied according to established protocols for guidelines. From this information, an algorithm for the nutritional management of people with T2D and prediabetes was created. Subsequently, algorithm nodes were populated with transcultural attributes to guide decisions. The resultant transcultural diabetes-specific nutrition algorithm (tDNA) was simplified and optimized for global implementation and validation according to current standards for CPG development and cultural adaptation. Thus, the tDNA is a tool to facilitate the delivery of nutrition therapy to patients with T2D and prediabetes in a variety of cultures and geographic locations. It is anticipated that this novel approach can reduce the burden of diabetes, improve quality of life, and save lives. The specific Southeast Asian and Asian Indian tDNA versions can be found in companion articles in this issue of Current Diabetes Reports.

Effect of Hospital Use of Oral Nutritional Supplementation on Length of Stay, Hospital Cost, and 30-Day Readmissions Among Medicare Patients With COPD

BACKGROUND COPD is a leading cause of death and disability in the United States. Patients with COPD are at a high risk of nutritional deficiency, which is associated with declines in respiratory function, lean body mass and strength, and immune function. Although oral nutritional supplementation (ONS) has been associated with improvements in some of these domains, the impact of hospital ONS on readmission risk, length of stay (LOS), and cost among hospitalized patients is unknown. METHODS Using the Premier Research Database, we first identified Medicare patients aged ≥ 65 years hospitalized with a primary diagnosis of COPD. We then identified hospitalizations in which ONS was provided, and used propensity-score matching to compare LOS, hospitalization cost, and 30-day readmission rates in a one-to-one matched sample of ONS and non-ONS hospitalizations. To further address selection bias among patients prescribed ONS, we also used instrumental variables analysis to study the association of ONS with study outcomes. Model covariates included patient and provider characteristics and a time trend. RESULTS Out of 10,322 ONS hospitalizations and 368,097 non-ONS hospitalizations, a one-to-one matched sample was created (N = 14,326). In unadjusted comparisons in the matched sample, ONS use was associated with longer LOS (8.7 days vs 6.9 days, P < .0001), higher hospitalization cost (

Use of probiotics in the management of chemotherapy-induced diarrhea: a case study.

14,223 vs

Transcultural Diabetes Nutrition Algorithm (tDNA): Venezuelan Application

9,340, P < .0001), and lower readmission rates (24.8% vs 26.6%, P = .0116). However, in instrumental variables analysis, ONS use was associated with a 1.9-day (21.5%) decrease in LOS, from 8.8 to 6.9 days (P < .01); a hospitalization cost reduction of

What is the significance of a physician shortage in nutrition medicine

1,570 (12.5%), from

Differences in Resource Utilization Between Patients With Diabetes Receiving Glycemia-Targeted Specialized Nutrition vs Standard Nutrition Formulas in U.S. Hospitals

12,523 to

Transcultural Diabetes Nutrition Algorithm:A Malaysian Application

10,953 (P < .01); and a 13.1% decrease in probability of 30-day readmission, from 0.34 to 0.29 (P < .01). CONCLUSIONS ONS may be associated with reduced LOS, hospitalization cost, and readmission risk in hospitalized Medicare patients with COPD.

The Transcultural Diabetes Nutrition Algorithm: A Canadian Perspective

Gastrointestinal disturbances (particularly diarrhea) are often induced in response to cancer treatments such as chemotherapy or radiation. Oral chemotherapeutic agents can induce diarrhea by damaging the intestinal lining. Two common oral drugs used in cancer treatment that are known to have gastrointestinal side effects are capecitabine and lapatinib. In this brief communication, the authors discuss a case study of a stage IV breast cancer patient whose chemotherapy-induced diarrhea was treated successfully with a multispecies combination of probiotics. This is a unique study in which grade 3 chemotherapy-induced diarrhea (characterized by 7-9 stools per day and associated with incontinence and abdominal cramping) was treated with only a multispecies combination of probiotics. Probiotics have been used to treat diarrhea in patients with irritable bowel syndrome, ulcerative colitis, pouchitis, and Crohns disease. More recently, probiotics have been used to treat chemotherapy-induced diarrhea in colon cancer patients. This case study demonstrates that the probiotics can also be used to treat severe cases of chemotherapy-induced diarrhea in breast cancer patients. The use of different probiotics in gastrointestinal diseases is an increasingly important area of study, and more research into this area is needed. This study demonstrates that probiotics should be considered for advanced breast cancer patients with chemotherapy-induced diarrhea.