Safer Glycemic Control Using Fructose-Based Enteral Formula—A Randomized Crossover Clinical Trial

Background: Glycemic control during nutritional therapy in patients under intensive care has shown a great importance in relation to morbidity and mortality. To avoid glycemic oscillation in patients under enteral nutrition, usually a low-carbohydrate diet is offered, but differing among themselves by carbohydrate type. A question that remains unanswered is whether the presence of fructose interferes with glycemic oscillation or not.

Objective: The aim of this clinical trial was to evaluate the effect of two diabetes-specific diets (fructose-based vs. maltodextrin-based) in the glycemic variability of critically ill patients. We hypothesized that patients under the fructose-based diet would have lower glycemic variability.

Materials and Methods: This is a randomized, active-controlled, double-blinded crossover clinical trial comparing diabetes-specific enteral formula with and without fructose in critically ill patients. Twenty-five patients, who developed hyperglycemia during intensive care unit stay, were included. Patients were randomized to receive each diet for 2 days. Capillary blood sample was taken every 4 hours and glycemic variability was defined as the difference between each time point. A significance level of 0.was defined for all statistical inferences.

Results: Patients which underwent the fructose-based diet reduced their glycemic variability against that under usual care overtime -11.92 mg/dL (95% CI -19.22 to -4.63 mg/dL), p = 0.0013 for between-group differences. We observed also some differences on specific time frames, especially in measures 6, 8 and 12. This effect was seen without any risk of hypoglycemia and complications.

Conclusions: Diabetes-specific enteral formula with fructose was associated with lower glycemic variability in critically ill patients when compared to diabetes-specific enteral formula without fructose.