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ORIGINAL ARTICLE
Year : 2020  |  Volume : 10  |  Issue : 4  |  Page : 200-205

Intermittent gastric feeds lower insulin requirements without worsening dysglycemia: A pilot randomized crossover trial


1 Department of Pulmonary Medicine, San Antonio Military Medical Center, San Antonio, TX, USA
2 Division of Trauma, Critical Care, and Acute Care Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
3 Department of Nutritional Medicine, San Antonio Military Medical Center, San Antonio, TX, USA
4 Department of Internal Medicine, San Antonio Military Medical Center, San Antonio, TX, USA
5 Division of Trauma, Acute Care and Critical Care Surgery, Pennsylvania State College of Medicine, Hershey, PA, USA

Correspondence Address:
Dr. Richard J Strilka
Division of Trauma, Critical Care, and Acute Care Surgery, University of Cincinnati Medical Center, 231 Albert Sabin Way (ML 0558), Cincinnati, OH 45267
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJCIIS.IJCIIS_112_19

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Introduction: We hypothesized that critically ill medical patients would require less insulin when fed intermittently. Methods: First, 26 patients were randomized to receive intermittent or continuous gastric feeds. Once at goal nutrition, data were collected for the first 4-hr data collection period. Next, the enteral feed type was switched, goal nutrition was repeated, and a second 4-h data collection period was completed. The primary endpoint was the total amount of insulin infused; secondary endpoints were glucose concentration mean, maximum, minimum, and standard deviation, as well as episodes of hypoglycemia. Results: Sixteen of the 26 patients successfully completed the protocol. One patient experienced a large, rapid, and sustained decline in insulin requirement from liver failure, creating a bias of lesser insulin in the intermittent arm; this patient was removed from the analysis. For the remaining 15 patients, the average total amount of insulin infused was 1.4 U/patient/h less following intermittent feeds: P =0.027, 95% confidence interval (0.02, 11.17), and effect size 0.6. Secondary endpoints were statistically similar. Conclusions: Critically ill medical patients who require an insulin infusion have a reduced insulin requirement when fed intermittently, whereas dysglycemia metrics are not adversely affected. A larger clinical study is required to confirm these findings.


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