The clinical and economic impact of the use of diabetes-specific enteral formula on ICU patients with type 2 diabetes

• Published in: Clinical nutrition (Edinburgh, Scotland) Vol. 36; no. 6; pp. 1567 - 1572
• Main Authors: Han, Yin-Yi, MD, Lai, Sheng-Ru, RD, Partridge, Jamie S., PhD, MBA, Wang, Michael Y., MD, MBA, Sulo, Suela, PhD, MSc, Tsao, Fang-Wei, MS, LD, Hegazi, Refaat A., MD, PhD, MS, MPH
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.12.2017
• Subjects: Adult; Aged; Aged, 80 and over; Body Mass Index; Critical illness; Critical Illness - economics; Critical Illness - therapy; Diabetes; Diabetes Mellitus, Type 2 - economics; Diabetes Mellitus, Type 2 - therapy; Diabetes-specific formulas; Enteral nutrition; Enteral Nutrition - economics; Female; Follow-Up Studies; Gastroenterology and Hepatology; Health economics; Humans; Insulin - blood; Insulin - therapeutic use; Intensive Care Units; Length of Stay; Male; Medical Records; Middle Aged; Retrospective Studies; Sensitivity and Specificity; Taiwan; Treatment Outcome; Young Adult; enteral nutrition; Non-DSF; critical illness; body mass index; T2D; EN; OHA; LOS; type 2 diabetes; diabetes-specific formula; non-diabetes-specific formula; DSF; length of stay; ICU; intensive care unit; diabetes-specific formulas; diabetes; oral hypoglycemic agent; health economics; BMI; Critical illness; Enteral nutrition; Diabetes-specific formulas; Health economics; Diabetes
• ISSN: 0261-5614; 1532-1983
• DOI: 10.1016/j.clnu.2016.09.027

Abstract Background & Aims 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. Methods 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. Results 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 (6,700 USD vs. 9,200 USD, P<0.0001). Conclusions The use of DSF in ICU patients with T2D is correlated with significant reduction in mortality and improved health economic outcomes.