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

BACKGROUND: As malnutrition negatively impacts hospital outcomes, hospitalised patients should receive proper nutritional management. Enteral nutrition (EN) is the most common route for non-volitional dietary support, usually fed four times/day. It is different from patients with volitional feeding who receive only three meals/day. This practice may affect blood glucose (BG) control in enteral feeding diabetes patients and increase nursing care’s working burden. As a result, the study aimed to compare BG control and enteral feeding complications between 3 and 4 times feeding/day in hospitalised diabetes patients who require EN. METHODS: A non-blind randomised controlled trial study was conducted in 37 types two diabetes hospitalised patients who required EN in Thammasat University hospital (TUH) from April 1 to December 31, 2019. The study patients were randomised and stratified by HbA1C at <8% or ≥8% to treat three meals or four meals/day. BG was controlled based on the insulin injection protocol of TUH. The study data was collected at least five days until the patients were stopped EN or discharged from the hospital. The primary outcome was a percentage of times BG was in controlled at ≤180mg/dl. The secondary outcomes were any feeding complications such as frequency of hypoglycemia, diarrhea and gastric residual volume over 100 ml before the next feeding time. RESULTS: 37 patients were included. 83% of the patients were female, and the mean age was 78.44 ± 8.14 and 74.11 ± 10.03 years old in three meals and four meals feeding group, respectively. There were none significant in mean percentage of BG control between three times and four 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. However, other complications were not significant between two groups. CONCLUSION: There was no clinically significant outcome on BG control and other complications between three and four times feeding/day in type 2 diabetes hospitalised patients. Therefore, three times feeding can be implied in clinical practice to reduce the burden of nursing care.