Intermittent vs Continuous Enteral Nutrition in Glycaemic Control of Diabetic ICU Patients

This randomized controlled clinical trial was conducted in the 25-bed tertiary intensive care unit of the Anesthesiology and Reanimation Department at Ankara Training and Research Hospital. Ethical approval was obtained from the institutional review board, and written informed consent was provided by the legal representatives of all participants. The study was carried out between December 2023 and June 2024, including 25 adult diabetic patients (14 males, 11 females; mean age: 73.44 ± 8.97 years) who were receiving clinical nutrition therapy in the ICU.

The purpose of this study was to compare the effects of continuous enteral nutrition (CE) and intermittent enteral nutrition (IE) on glycemic control and selected metabolic parameters. Sample size was calculated using G*Power software, indicating that a minimum of 24 participants (12 per group) would be needed to detect a large effect size (1.39) with 80% power and a 5% type I error rate.

All patients initially began enteral feeding at 40 mL/hour according to standard ICU protocol, with gradual increases based on individual tolerance. Once patients reached 80% of their estimated energy requirement without feeding intolerance, they were randomized into one of two groups:

CE group (Control, n=12): Received enteral nutrition in a near-continuous fashion with scheduled breaks.

IE group (n=13): Received nutrition in defined intermittent periods, alternating with fasting intervals.

Energy needs were estimated using the ESPEN guideline formula (25 kcal/kg/day), and a diabetic-specific enteral formula was administered accordingly.

Blood glucose levels were measured five times per day (06:00, 11:00, 16:00, 21:00, and 01:00) using a bedside glucometer. In addition, all participants had the following data collected:

Clinical scores: SOFA, mNUTRIC, and APACHE II

Baseline and Day 7 measurements of serum total cholesterol and triglycerides

Daily laboratory parameters: serum glucose, ALT, AST, GGT, albumin, CRP, BUN, creatinine, sodium, and potassium

The intervention lasted for 7 days and aimed to evaluate whether the method of enteral nutrition delivery (CE vs. IE) affects metabolic responses and glycemic outcomes in diabetic ICU patients. Findings from this study may help inform nutritional strategies in critical care for individuals with diabetes.

Inclusion criteria

• Age 18 or older

Diagnosis of diabetes

Receiving enteral nutrition

Indication for at least 7 days of ICU admission to perform the study

Exclusion criteria

• Under 18 years old

Having specific needs that would require a completely different type of treatment, such as cancer or cystic fibrosis

Pregnancy

Expected to stay in the ICU for less than 7 days

Receiving oral feeding or TPN (Total Parenteral Nutrition)