The Comparison of the Effects of 3 Meals Feeding a Day and 4 Meals Feeding a Day in Type 2 Diabetes Mellitus Hospitalized Patients in Thammasat University Hospital on Blood Sugar Control and Enteral Feeding Complications

Abstract

Kwansuphang Wongwatanasanti38685* and Sanit Wichansawakun38686

Background: Malnutrition has a negative impacted hospital outcome; hospitalized patients should receive proper nutritional management. Enteral Nutrition (EN) is the most common route for non-volitional dietary support, usually fed 4 times/day, different from patients with volitional feeding who receive only 3 meals/day. This practice may affect Blood Glucose (BG) control and increase nursing care's working burden. The aim of this study to compare BG control and enteral feeding complications between 3 and 4 times feeding/day in diabetes hospitalized patients who require EN.

Methods: A non-blind randomized controlled trial study of type 2 diabetes hospitalized patients who required EN in Thammasat University Hospital (TUH) from April 1 to December 31, 2019. The study patients were randomized and stratified by Glycated hemoglobin (HbA1C) at <8% or ≥ 8% to treat 3 meals or 4 meals/day at least 5 days or until stopped EN or discharged. The primary outcome was a percentage of times BG was in controlled at ≤ 180 mg/dl. Secondary outcomes were any feeding complications.

Results: 37 patients were included. 83% of the patients were female. There were none significant in mean percentage of BG control between 3 times and 4 times/day either in HbA1C<8% and HbA1C ≥ 8% (52.21% and 68.43%, p-value=0.192 and 54.29% and 55.10%, p-value=0.942, respectively). Percentage of hypoglycemic events were none significant in 3 vs. 4 times feeding at 1.70% vs. 0.99%, p-value=0.552 and 2.53% vs. 2.00%, p-value=0.727 in HbA1C<8% and HbA1C ≥ 8%, respectively. Other complications were not significant between 2 groups.

Conclusion: There was no clinically significant outcome on BG control and other complications between 3 and 4 times feeding/day in type 2 diabetes hospitalized patients. Three times feeding can be implied in clinical practice to reduce burden of nursing care.