title: The clinical and economic impact of the use of diabetes-specific enteral formula on ICU patients with type 2 diabetes.
abstract: Patients admitted to intensive care units (ICUs) often need enteral nutrition (EN) support. For patients with type 2 diabetes (T2D), standard EN formulas may not provide ideal nutrients. The purpose was to investigate whether use of a diabetes-specific formula (DSF) could provide clinical and health economic benefits (compared to standard formulas) in critically ill patients with T2D.
  
  
  
  This study was a retrospective analysis of medical records and expenditure data covering a 5-year period (2009-2013) from the hospitalization database of the National Taiwan University Hospital. Records of ICU patients who had T2D and were receiving enteral feeding with either the DSF or non-diabetes-specific formula (non-DSF) for at least 5 days were included in the analysis. Mortality, ICU length of stay (LOS), diabetes-related medications, and total costs of care (including all costs covered by the National Health Insurance and private expenses) were considered as the primary outcomes.
  
  
  
  A total of 158 patient records were analyzed in the DSF group and 794 in the non-DSF group. The baseline demographics including age, gender, weight, body mass index (BMI), and comorbidity patterns were mostly comparable between the groups. Compared to those receiving non-DSF, patients with T2D receiving DSF were found to have significantly decreased mortality (5.1% vs. 12.3%, P = 0.0118) and reduced need for insulin prescription (29.1% vs. 38.4%, P = 0.0269). ICU LOS was shorter for DSF patients, but no statistical difference was found (13.0 days vs. 15.1 days, P = 0.1843). However, significantly lower total ICU costs were reported for DSF patients (6700 USD vs. 9200 USD, P < 0.0001).
  
  
  
  The use of DSF in ICU patients with T2D is correlated with significant reduction in mortality and improved health economic outcomes.
authors.affiliation: Department of Traumatology, National Taiwan University Hospital, Taiwan. Electronic address: noviahan@gmail.com.
authors.forename: Yin-Yi
authors.initials: YY
authors.lastname: Han
authors.affiliation: Department of Dietetics, National Taiwan University Hospital, Taiwan.
authors.forename: Sheng-Ru
authors.initials: SR
authors.lastname: Lai
authors.affiliation: Abbott Nutrition Research & Development, Columbus, OH, USA.
authors.forename: Jamie S
authors.initials: JS
authors.lastname: Partridge
authors.affiliation: Abbott Nutrition Research & Development, Taiwan.
authors.forename: Michael Y
authors.initials: MY
authors.lastname: Wang
authors.affiliation: Abbott Nutrition Research & Development, Chicago, IL, USA.
authors.forename: Suela
authors.initials: S
authors.lastname: Sulo
authors.affiliation: Abbott Nutrition Research & Development, Taiwan.
authors.forename: Fang-Wei
authors.initials: FW
authors.lastname: Tsao
authors.affiliation: Abbott Nutrition Research & Development, Columbus, OH, USA; Faculty of Medicine, Mansoura University, Egypt.
authors.forename: Refaat A
authors.initials: RA
authors.lastname: Hegazi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D016638:Critical Illness / Q000191:economics / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000191:economics* / Q000628:therapy*; D004750:Enteral Nutrition / Q000191:economics*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007328:Insulin / Q000097:blood / Q000627:therapeutic use; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013624:Taiwan; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007328:Insulin
keywords: Critical illness; Diabetes; Diabetes-specific formulas; Enteral nutrition; Health economics