Challenges of clinical hyperglycemia and nutritional needs

As the prevalence of diabetes continues to increase, comorbid hyperglycemia is more common in hospitalized patients, with approximately 50% of diabetic patients undergoing at least one surgery in their lifetime and at least 10% to 20% of surgical patients having comorbid diabetes. Under the influence of trauma and surgery, stress hyperglycemia is a common clinical complication in the perioperative period. The risk of hyperglycemia is significantly associated with the risk of infection, leading to prolonged hospitalization and increased morbidity and mortality. Therefore, attention needs to be paid to the proper nutritional support of hyperglycemic patients.

Nutritional support for hyperglycemic patients

In 2020, ESPEN put forward recommendations and guidance on perioperative glycemic control in "Perioperative Nutrition: ESPEN Expert Group Recommendations". Combined with the "Guidelines for the Prevention and Treatment of Type 2 Diabetes in China" put forward by the Diabetes Branch of the Chinese Medical Association in the same year, the following nutritional recommendations are available for patients with diagnosed diabetes and for patients with diagnosed diabetes who develop hyperglycemia during the perioperative or postoperative period.

• Timely monitoring and care

• Use low glycemic index GI sources of nutrition

• Intake of dietary fiber

• Pay attention to perioperative hyperglycemia

• Pay attention to the symptoms of hyperglycemia in combination with other diseases.

Advantages of hyperglycemia specific disease formula

Rationally proportioned nutritional formula can ensure the provision of adequate nutrition while reducing blood glucose fluctuations and improving the body's blood glucose metabolic status to reduce complications caused by hyperglycemia and severe blood glucose fluctuations. Hyperglycemia-specific disease formulas can provide

• Low GI carbohydrates

• Insoluble dietary fiber

• Resistant dextrins

• Medium chain fatty acids (MCFA)

Rich in protein and lipids

In the stressful hyperglycemic state of the perioperative period, the gastrointestinal tract is prone to ulcers and other damage, and the immunity of the gastrointestinal mucosal barrier is reduced. Rich and rapidly absorbable proteins can quickly repair damage to the gastrointestinal tract, and together with a large amount of lipids, they can replace some sugar substances for the the body's function and reduce the risk of blood sugar fluctuations.

The role of slow-release starch, fructose and other sugar substances

The large molecular structure of slow-release starch can slow down the rate of hydrolysis by amylase, thus slowing the body's absorption of glucose. In combination with rich protein and lipid for the body's energy supply, slow-release sugar substances effectively reduce the body's blood sugar fluctuations and hyperglycemia.

The role of dietary fiber

Several studies have shown that dietary fiber can improve the symptoms of hyperglycemia in the body through various mechanisms. Dietary fiber not only improves the intestinal environment as prebiotics and regulates the normal absorption of various nutrients, but also increases the viscosity of food, slows down the evacuation rate of food emptying in the gastrointestinal tract, and also delays the absorption of glucose from food.

Conclusion

Diabetes in epidemiology is only a local manifestation of clinical hyperglycemia, and paying attention to the state of hyperglycemia and its damage to the organism can help us deal with more complications in time. Because clinical hyperglycemia symptoms originate from nutritional and endocrine mechanisms themselves, they also challenge the formulation of nutritional interventions. We hope to help patients with clinical hyperglycemia symptoms effectively reduce treatment risk and improve treatment outcome by providing more rational formulations.

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