Dietary Management of Blood Glucose in Medical Critically Ill Overweight and Obese Patients: An Open-Label Randomized Trial

Todd W. Rice, D. Clark Files, Peter E. Morris, Andrew C. Bernard, Thomas R. Ziegler, John W. Drover, John P. Kress, Kealy R. Ham, Dominik J. Grathwohl, Maureen B. Huhmann, Juan B.Ochoa Gautier

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Background: Enteral nutrition (EN) increases hyperglycemia due to high carbohydrate concentrations while providing insufficient protein. The study tested whether an EN formula with very high-protein- and low-carbohydrate-facilitated glucose control delivered higher protein concentrations within a hypocaloric protocol. Methods: This was a multicenter, randomized, open-label clinical trial with parallel design in overweight/obese mechanically ventilated critically ill patients prescribed 1.5 g protein/kg ideal body weight/day. Patients received either an experimental very high-protein (37%) and low-carbohydrate (29%) or control high-protein (25%) and conventional-carbohydrate (45%) EN formula. Results: A prespecified interim analysis was performed after enrollment of 105 patients (52 experimental, 53 control). Protein and energy delivery for controls and experimental groups on days 1–5 were 1.2 ± 0.4 and 1.1 ± 0.3 g/kg ideal body weight/day (P =.83), and 18.2 ± 6.0 and 12.5 ± 3.7 kcals/kg ideal body weight/day (P <.0001), respectively. The combined rate of glucose events outside the range of >110 and ≤150 mg/dL were not different (P =.54, primary endpoint); thereby the trial was terminated. The mean blood glucose for the control and the experimental groups were 138 (−SD 108, +SD 177) and 126 (−SD 99, +SD 160) mg/dL (P =.004), respectively. Mean rate of glucose events >150 mg/dL decreased (Δ = −13%, P =.015), whereas that of 80–110 mg/dL increased (Δ = 14%, P =.0007). Insulin administration decreased 10.9% (95% CI, −22% to 0.1%; P =.048) in the experimental group relative to the controls. Glycemic events ≤80 mg/dL and rescue dextrose use were not different (P =.23 and P =.53). Conclusions: A very high-protein and low-carbohydrate EN formula in a hypocaloric protocol reduces hyperglycemic events and insulin requirements while increasing glycemic events between 80–110 mg/dL.

Original languageEnglish
Pages (from-to)471-480
Number of pages10
JournalJournal of Parenteral and Enteral Nutrition
Issue number4
StatePublished - May 2019

Bibliographical note

Funding Information:
Conflicts of interest: This study was funded by Nestlé Health Science. MBH and JBO received salary from Nestlé Health Science. DJG received salary from Nestlé Research Center.

Publisher Copyright:
© 2018 Nestle Health Science. Journal of Parenteral and Enteral Nutrition published by Wiley Periodicals, Inc. on behalf of American Society for Parenteral and Enteral Nutrition.


  • critical care
  • enteral formula
  • enteral nutrition
  • nutrition
  • nutrition support practice
  • research and diseases

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics


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