{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T13:08:02Z","timestamp":1788959282978,"version":"build-2803163510"},"reference-count":40,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"unspecified","delay-in-days":8,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Abbott Nutrition Division","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"DOI":"10.13039\/100000041","name":"American Diabetes Association","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100000041","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Diab Res Care"],"accepted":{"date-parts":[[2026,8,9]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>\n                    This systematic review was conducted to evaluate the effects of diabetes-specific nutritional formulas (DSNF) in tube feeding on multiple outcomes in patients with hyperglycemia in real-world clinical settings. Randomized controlled trials (RCTs) comparing outcomes of patients receiving tube feeding with DSNF versus standard formulas were evaluated. RCTs in critical care and long-term care settings were addressed separately. Outcomes reported by two or more RCTs per clinical setting were evaluated, and those addressed by three or more RCTs were assessed using meta-analysis. Five RCTs allocating 483 patients in critical care and three RCTs allocating 137 patients in long-term care met inclusion criteria. DSNF showed advantages over standard formulas for glycemic control in both populations. Meta-analysis of studies enrolling critically ill patients found reductions in mean blood glucose (mean difference (MD) \u22120.54\u2009mmol\/L (95%\u2009CI \u22120.78 to \u22120.31), p&lt;0.001; I\n                    <jats:sup>2<\/jats:sup>\n                    =9%; moderate certainty), coefficient of variation of glucose (MD \u22126.56% (95% CI \u221212.55% to \u22120.57%), p=0.032; I\n                    <jats:sup>2<\/jats:sup>\n                    =98%; low certainty) and SD of glucose (\u22120.77\u2009mmol\/L (95%\u2009CI \u22121.49 to \u22120.06), p\n                    <jats:italic>=<\/jats:italic>\n                    0.035; I\n                    <jats:sup>2<\/jats:sup>\n                    =98%; low certainty). Meta-analysis of the studies enrolling patients in long-term care found a reduction in hemoglobin A1c (\u22120.92% (95% CI \u22121.72% to \u22120.13%), p\n                    <jats:italic>=<\/jats:italic>\n                    0.023; I\n                    <jats:sup>2<\/jats:sup>\n                    =85%; low certainty). Findings for other outcomes were uncertain due to a lack of reporting in the included publications, inconsistent findings across studies, small sample sizes or lack of overall statistical significance. Evidence from this review demonstrated that DSNF in tube feeding provides statistically significant improvements in glycemia in both critically ill and long-term care populations with hyperglycemia compared with standard formulas. However, small effect sizes, imprecision and substantial statistical heterogeneity reduced certainty in the strength of evidence for most outcomes. DSNF is an important clinical tool to control hyperglycemia among critically ill and long-term care patients and should continue to be assessed for effectiveness in improving outcomes.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>PROSPERO registration number<\/jats:bold>\n                  <\/jats:p>\n                  <jats:p>CRD420251105442.<\/jats:p>","DOI":"10.1136\/bmjdrc-2026-006281","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T12:35:11Z","timestamp":1788957311000},"page":"e006281","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Diabetes-specific nutritional formulas for tube feeding in patients with hyperglycemia: a systematic review and meta-analysis"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1919-0268","authenticated-orcid":false,"given":"Osama","family":"Hamdy","sequence":"first","affiliation":[{"name":"Joslin Diabetes Center, Boston, Massachusetts, USA"},{"name":"Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raveendhara R","family":"Bannuru","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, Massachusetts, USA"},{"name":"American Diabetes Association, Arlington, Virginia, USA"},{"name":"Supercharged Scientific, Wellesley, MA, USA"},{"name":"Diabetes Education For All Foundation, New York, NY, USA"},{"name":"Tufts University School of Medicine, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena A","family":"Christofides","sequence":"additional","affiliation":[{"name":"Endocrinology Associates, Columbus, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea J","family":"Glenn","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Food Studies, New York University, New York, NY, USA"},{"name":"Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuha","family":"El Sayed","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Supercharged Scientific, Wellesley, MA, USA"},{"name":"Diabetes Education For All Foundation, New York, NY, USA"},{"name":"Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1190-9656","authenticated-orcid":false,"given":"Katherine","family":"Fazioli","sequence":"additional","affiliation":[{"name":"American Diabetes Association, Arlington, Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ka Hei Karen","family":"Lau","sequence":"additional","affiliation":[{"name":"Joslin Diabetes Center, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meredith","family":"Noble","sequence":"additional","affiliation":[{"name":"American Diabetes Association, Arlington, Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5670-7388","authenticated-orcid":false,"given":"Tracy C","family":"Shields","sequence":"additional","affiliation":[{"name":"American Diabetes Association, Arlington, Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3252-5026","authenticated-orcid":false,"given":"Guillermo E","family":"Umpierrez","sequence":"additional","affiliation":[{"name":"Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey I","family":"Mechanick","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine, Mount Sinai, New York, NY, USA"},{"name":"Mount Sinai Fuster Heart Hospital, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"key":"2026090905350800000_14.5.e006281.1","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1080\/21548331.2015.1022493","article-title":"Managing hyperglycemia and diabetes in patients receiving enteral feedings: A health system approach","volume":"43","author":"Mabrey","year":"2015","journal-title":"Hosp Pract"},{"key":"2026090905350800000_14.5.e006281.2","doi-asserted-by":"publisher","DOI":"10.1177\/193229680900300604"},{"key":"2026090905350800000_14.5.e006281.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.beem.2011.05.004"},{"key":"2026090905350800000_14.5.e006281.4","doi-asserted-by":"crossref","first-page":"591","DOI":"10.4097\/kjae.2017.70.6.591","article-title":"Glycemic control in acute illness","volume":"70","author":"Egi","year":"2017","journal-title":"Korean J Anesthesiol"},{"key":"2026090905350800000_14.5.e006281.5","doi-asserted-by":"publisher","DOI":"10.1007\/s11892-012-0335-y"},{"key":"2026090905350800000_14.5.e006281.6","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/j.clnu.2016.09.010","article-title":"Carbohydrates and insulin resistance in clinical nutrition: Recommendations from the ESPEN expert group","volume":"36","author":"Barazzoni","year":"2017","journal-title":"Clin Nutr"},{"key":"2026090905350800000_14.5.e006281.7","doi-asserted-by":"publisher","DOI":"10.1177\/0148607115621863"},{"key":"2026090905350800000_14.5.e006281.8","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.ejim.2024.11.018","article-title":"Treatment of hospitalized patient with hyperglycemia: An EFIM critically appraised and adapted guideline","volume":"132","author":"Uyaro\u011flu","year":"2025","journal-title":"Eur J Intern Med"},{"key":"2026090905350800000_14.5.e006281.9","doi-asserted-by":"crossref","DOI":"10.3390\/jcm10102154","article-title":"A Practical Guide for the Management of Steroid Induced Hyperglycaemia in the Hospital","volume":"10","author":"Aberer","year":"2021","journal-title":"J Clin Med"},{"key":"2026090905350800000_14.5.e006281.10","doi-asserted-by":"publisher","DOI":"10.2337\/dc23-S016"},{"key":"2026090905350800000_14.5.e006281.11","unstructured":"Gianchandani RY , Iyengar JL , Butler SO , et al . 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