title: Enteral nutritional support and use of diabetes-specific formulas for patients with diabetes: a systematic review and meta-analysis.
abstract: OBJECTIVE
  The aim of this systematic review was to determine the benefits of nutritional support in patients with type 1 or type 2 diabetes.
  
  
  METHODS
  Studies utilizing an enteral nutritional support intervention (oral supplements or tube feeding) were identified using electronic databases and bibliography searches. Comparisons of interest were nutritional support versus routine care and standard versus diabetes-specific formulas (containing high proportions of monounsaturated fatty acids, fructose, and fiber). Outcomes of interest were measures of glycemia and lipid status, medication requirements, nutritional status, quality of life, complications, and mortality. Meta-analyses were performed where possible.
  
  
  RESULTS
  A total of 23 studies (comprising 784 patients) of oral supplements (16 studies) and tube feeding (7 studies) were included in the review, and the majority compared diabetes-specific with standard formulas. Compared with standard formulas, diabetes-specific formulas significantly reduced postprandial rise in blood glucose (by 1.03 mmol/l [95% CI 0.58-1.47]; six randomized controlled trials [RCTs]), peak blood glucose concentration (by 1.59 mmol/l [86-2.32]; two RCTs), and glucose area under curve (by 7.96 mmol.l(-1).min(-1) [2.25-13.66]; four RCTs, i.e., by 35%) with no significant effect on HDL, total cholesterol, or triglyceride concentrations. In addition, individual studies reported a reduced requirement for insulin (26-71% lower) and fewer complications with diabetes-specific compared with standard nutritional formulas.
  
  
  CONCLUSIONS
  This systematic review shows that short- and long-term use of diabetes-specific formulas as oral supplements and tube feeds are associated with improved glycemic control compared with standard formulas. If such nutritional support is given long term, this may have implications for reducing chronic complications of diabetes, such as cardiovascular events.
authors.affiliation: Institute of Human Nutrition, University of Southampton, Southampton General Hospital, MP 113 F Level, Tremona Road, Southampton, SO16 6YD, UK. m.elia@soton.ac.uk
authors.forename: Marinos
authors.initials: M
authors.lastname: Elia
authors.forename: Antonio
authors.initials: A
authors.lastname: Ceriello
authors.forename: Heiner
authors.initials: H
authors.lastname: Laube
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Sinclair
authors.forename: Meike
authors.initials: M
authors.lastname: Engfer
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Stratton
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D003920:Diabetes Mellitus / Q000178:diet therapy*; D003927:Diet, Diabetic; D019587:Dietary Supplements; D004750:Enteral Nutrition; D005526:Food, Formulated; D006801:Humans
chemical_list: D001786:Blood Glucose