USE OF A REDUCED-CARBOHYDRATE, MODIFIED-FAT ENTERAL FORMULA FOR IMPROVING METABOLIC CONTROL AND CLINICAL OUTCOMES IN LONG-TERM-CARE RESIDENTS WITH TYPE-2 DIABETES - RESULTS OF A PILOT TRIAL

Physiologic responses of 30 enterally-fed long-term care residents wit h type 2 diabetes receiving total nutrition support via either a disea se-specific (reduced-carbohydrate, modified-fat) formula or a standard high-carbohydrate formula for 3 mo were compared. Objectives of the s tudy included evaluating metabolic response (glycemic control and lipi ds) and clinical outcomes. Thirty-four subjects requiring total entera l nutrition support by tube were enrolled in this prospectively random ized, double-blind, controlled, parallel group 3-mo pilot trial. Thirt y were evaluable in that they completed 4 wk. Twenty-seven completed a ll 12 wk. The groups were well-matched for physiologic and demographic parameters at baseline. Fasting serum glucose and capillary (fingerst ick) glucose values demonstrated better control in the disease-specifi c formula-fed group. Serum lipid profiles of this group were similar t o or better than those of the standard formula-fed group. The amount o f insulin administered to insulin-using subjects in the disease-specif ic formula-fed group was consistently less than before initiation of t he formula, whereas the amount administered was consistently higher in the group fed the standard formula. Overall, subjects randomized to t he disease-specific formula experienced better numerical biochemical c ontrol and better clinical outcomes when expressed on a numerical and percentage basis. These included surrogate markers of diabetes control such as serum glucose and glycohemoglobin, as well as clinical outcom es such as incidence of infections and pressure ulcers. These findings confirm that the disease-specific formula provides better glycemic co ntrol, poses no risk to lipoprotein metabolism, and provides for bette r clinical outcomes. Nutrition 1998;14:529-534. (C)Elsevier Science In c. 1998.