{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T10:08:27Z","timestamp":1779271707108,"version":"3.51.4"},"reference-count":32,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: This study evaluated whether a low-carbohydrate diabetes-specific enteral formula improves glycemic control and insulin requirement compared with a standard enteral formula in critically ill patients with type 2 diabetes mellitus (T2DM) under pandemic-related product accessibility constraints. Methods: This retrospective observational study included adult ICU patients with T2DM receiving enteral nutrition between August 2021 and August 2023. Patients were grouped according to enteral formula type as standard enteral formula or diabetes-specific enteral formula. All patients received continuous nasogastric enteral feeding according to routine ICU practice. Glycemic control was managed using intravenous insulin infusion protocols. One hundred eligible patients were analyzed. Results: Fifty patients were included in each group. Baseline characteristics were broadly comparable, although differences in BMI and feeding rate were observed. Mean glucose level, daily insulin requirement, hypoglycemia, hyperglycemia, and glycemic variability were similar between groups (all p &gt; 0.05). However, the number and percentage of days within the target glycemic range were higher in the diabetes-specific formula group (both p = 0.021). Clinical outcomes were comparable between groups. In multivariable analysis, mean glucose level independently predicted insulin requirement and glycemic variability, whereas formula type did not. Product-related costs were lower in the diabetes-specific formula group (all p &lt; 0.001). Conclusions: Diabetes-specific enteral formula did not improve mean glucose level or insulin requirement in critically ill patients with T2DM, although it was associated with better maintenance of the target glycemic range and lower product-related costs. Enteral formula choice should therefore be individualized rather than routinely determined by diabetes status alone.<\/jats:p>","DOI":"10.3390\/nu18101615","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T09:12:41Z","timestamp":1779268361000},"page":"1615","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Glycemic Control and Insulin Requirement According to Enteral Formula Type in Critically Ill Patients with Type 2 Diabetes: A Retrospective Comparative Study"],"prefix":"10.3390","volume":"18","author":[{"given":"Serpil","family":"Ekin","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa 16310, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3347-8292","authenticated-orcid":false,"given":"Derful","family":"G\u00fclen","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa 16310, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3306-3107","authenticated-orcid":false,"given":"\u0130lkay","family":"Ceylan","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa 16310, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6327-4573","authenticated-orcid":false,"given":"Buket","family":"\u00d6zyaprak","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa 16310, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8574-7460","authenticated-orcid":false,"given":"Kamer","family":"K\u0131l\u0131n\u00e7","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa 16310, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asl\u0131han","family":"\u00d6zt\u00fcrk","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Dietetics, Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa 16310, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e93","DOI":"10.1097\/CCM.0b013e318283d124","article-title":"Stress hyperglycemia: An essential survival response!","volume":"41","author":"Marik","year":"2013","journal-title":"Crit. Care Med."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"American Diabetes Association Professional Practice Committee (2026). Diabetes Care in the Hospital: Standards of Care in Diabetes\u20142026. Diabetes Care, 49, S339\u2013S355.","DOI":"10.2337\/dc26-S016"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1093\/bja\/aeu187","article-title":"Metabolic response to the stress of critical illness","volume":"113","author":"Preiser","year":"2014","journal-title":"Br. J. Anaesth."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1097\/CCM.0000000000006173","article-title":"Society of Critical Care Medicine guidelines on glycemic control for critically ill children and adults 2024: Executive summary","volume":"52","author":"Honarmand","year":"2024","journal-title":"Crit. Care Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1007\/s00125-024-06102-x","article-title":"Diabetes and infection: Review of the epidemiology, mechanisms and principles of treatment","volume":"67","author":"Holt","year":"2024","journal-title":"Diabetologia"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"107911","DOI":"10.1016\/j.jstrokecerebrovasdis.2024.107911","article-title":"Stress hyperglycemia is associated with longer ICU length of stay after endoscopic intracerebral hemorrhage evacuation","volume":"33","author":"Vasa","year":"2024","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1097\/SLA.0b013e3181f4e499","article-title":"Acute glucose elevation is highly predictive of infection and outcome in critically injured trauma patients","volume":"252","author":"Bochicchio","year":"2010","journal-title":"Ann. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e161","DOI":"10.1097\/CCM.0000000000006174","article-title":"Society of Critical Care Medicine guidelines on glycemic control for critically ill children and adults 2024","volume":"52","author":"Honarmand","year":"2024","journal-title":"Crit. Care Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.clnesp.2019.02.013","article-title":"The effect of a low carbohydrate formula on glycaemia in critically ill enterally fed adult patients with hyperglycaemia: A blinded randomised feasibility trial","volume":"31","author":"Doola","year":"2019","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1567","DOI":"10.1016\/j.clnu.2016.09.027","article-title":"The clinical and economic impact of the use of diabetes-specific enteral formula on ICU patients with type 2 diabetes","volume":"36","author":"Han","year":"2017","journal-title":"Clin. Nutr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1186\/s13054-015-1108-1","article-title":"Diabetes-specific enteral nutrition formula in hyperglycemic, mechanically ventilated, critically ill patients: A prospective, open-label, blind-randomized, multicenter study","volume":"19","author":"Mesejo","year":"2015","journal-title":"Crit. Care"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"175","DOI":"10.3758\/BF03193146","article-title":"G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences","volume":"39","author":"Faul","year":"2007","journal-title":"Behav. Res. Methods"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1002\/jpen.1428","article-title":"Volume-based vs. rate-based enteral nutrition in the intensive care unit: Impact on nutrition delivery and glycemic control","volume":"43","author":"Roberts","year":"2019","journal-title":"JPEN J. Parenter. Enter. Nutr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1671","DOI":"10.1016\/j.clnu.2023.07.011","article-title":"ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit","volume":"42","author":"Singer","year":"2023","journal-title":"Clin. Nutr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4266\/acc.2022.00094","article-title":"2021 KSCCM clinical practice guidelines for pain, agitation, delirium, immobility, and sleep disturbance in the intensive care unit","volume":"37","author":"Seo","year":"2022","journal-title":"Acute Crit. Care"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3940","DOI":"10.1016\/j.clnu.2021.04.030","article-title":"Association of specialized enteral nutrition with glycemic control and clinical outcomes in critically ill patients: A meta-analysis of randomized controlled trials","volume":"40","author":"Eckert","year":"2021","journal-title":"Clin. Nutr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1002\/jpen.1045","article-title":"Glycemic effects of a low-carbohydrate enteral formula compared with an enteral formula of standard composition in critically ill patients: An open-label randomized controlled clinical trial","volume":"42","author":"Rijkenberg","year":"2018","journal-title":"JPEN J. Parenter. Enter. Nutr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1177\/0148607112452001","article-title":"ASPEN clinical guidelines: Nutrition support of adult patients with hyperglycemia","volume":"37","author":"McMahon","year":"2013","journal-title":"JPEN J. Parenter. Enter. Nutr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1186\/cc12537","article-title":"Clinical review: Consensus recommendations on measurement of blood glucose and reporting glycemic control in critically ill adults","volume":"17","author":"Finfer","year":"2013","journal-title":"Crit. Care"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1002\/ncp.10652","article-title":"Low-carbohydrate, high-fat enteral formulas for managing glycemic control in patients who are critically ill: A review of the evidence","volume":"37","author":"Burslem","year":"2022","journal-title":"Nutr. Clin. Pract."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"R37","DOI":"10.1186\/cc12547","article-title":"Diabetic status and the relation of the three domains of glycemic control to mortality in critically ill patients: An international multicenter cohort study","volume":"17","author":"Krinsley","year":"2013","journal-title":"Crit. Care"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1038\/s41430-018-0111-4","article-title":"Different enteral nutrition formulas have no effect on glucose homeostasis but on diet-induced thermogenesis in critically ill medical patients: A randomized controlled trial","volume":"72","author":"Wewalka","year":"2018","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1038\/s41387-024-00292-4","article-title":"Effect of a diabetes-specific formula in non-diabetic inpatients with stroke: A randomized controlled trial","volume":"14","year":"2024","journal-title":"Nutr. Diabetes"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.1056\/NEJMoa2304855","article-title":"Tight blood-glucose control without early parenteral nutrition in the ICU","volume":"389","author":"Gunst","year":"2023","journal-title":"N. Engl. J. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"192","DOI":"10.63729\/TJIC.2025.662","article-title":"Glycemic variability and mortality in critically ill patients: Higher risk in non-diabetic patients","volume":"23","author":"Cengizhan","year":"2025","journal-title":"Turk. J. Intensive Care"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1186\/s13613-015-0077-5","article-title":"Associations between bolus infusion of hydrocortisone, glycemic variability and insulin infusion rate variability in critically ill patients under moderate glycemic control","volume":"5","author":"Binnekade","year":"2015","journal-title":"Ann. Intensive Care"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.diabres.2009.09.018","article-title":"Bedside capillary blood glucose measurements in critically ill patients: Influence of catecholamine therapy","volume":"87","author":"Hassen","year":"2010","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.clinthera.2022.12.007","article-title":"Stress-induced hyperglycemia ratio as an independent risk factor of in-hospital mortality in nonresuscitation intensive care units: A retrospective study","volume":"45","author":"Tian","year":"2023","journal-title":"Clin. Ther."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1007\/s12028-011-9507-x","article-title":"Is critical illness neuromyopathy and duration of mechanical ventilation decreased by strict glucose control?","volume":"14","author":"Wieske","year":"2011","journal-title":"Neurocrit. Care"},{"key":"ref_30","first-page":"463","article-title":"Gastrointestinal function in critically ill patients","volume":"26","author":"Bachmann","year":"2023","journal-title":"Curr. Opin. Clin. Nutr. Metab. Care"},{"key":"ref_31","first-page":"e78758","article-title":"Continuous Feeding Insulin Injection (CFII): A New Simple Method to Stabilize Severe Glucose Variability and Nutrition Delivery in Critically Ill Patients","volume":"17","author":"Ohshiro","year":"2025","journal-title":"Cureus"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"368504251392606","DOI":"10.1177\/00368504251392606","article-title":"Which is better for glycemic control? Bolus, intermittent (nocturnal pause) or continuous enteral feeding in septic critically ill patients","volume":"108","author":"Goksu","year":"2025","journal-title":"Sci. Prog."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/10\/1615\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T09:34:48Z","timestamp":1779269688000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/10\/1615"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,20]]},"references-count":32,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["nu18101615"],"URL":"https:\/\/doi.org\/10.3390\/nu18101615","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,20]]}}}