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Seleccionamos los puntos de controversia del soporte nutricional en el paciente diabético a partir de las guías clínicas internacionales, de la búsqueda por Internet, PubMed y el registro de la biblioteca Cochrane. Respecto a la dieta oral, el índice glucémico de los alimentos es una herramienta útil para seleccionar los alimentos de la dieta del paciente con diabetes mellitus tipo 2 (A); la dieta rica en grasas monoinsaturadas en el paciente con diabetes mellitus tipo 2 puede ser una alternativa para elevar los valores plasmáticos de colesterol ligado a lipoproteínas de alta densidad (A), pero no es esperable que mejore el control glucémico (B), y se ha de insistir en que sustituye otra fuente de energía y no es una suplementación, para evitar el aumento de peso (C). Respecto a la fórmula ideal de nutrición enteral para el paciente con diabetes mellitus, las fórmulas ricas en grasas monoinsaturadas producen una menor respuesta glucémica posprandial que las ricas en hidratos de carbono (A), pero sin modificar los parámetros de control glucémico a largo plazo (B). Sólo en los casos de hiperglucemia de estrés en la UCI han demostrado disminuir los requerimientos de insulina (C); la utilización de hidratos de carbono de absorción lenta, como la fructosa, sólo es eficaz si se añade fibra (B), y el efecto de la fibra sola no ha demostrado tener eficacia (B). Respecto a la nutrición parenteral, se puede considerar que la insulinoterapia intensiva en los pacientes con nutrición parenteral de UCI quirúrgica puede tener efectos beneficiosos sobre su mortalidad (B).
Palabras clave:
Dieta
Nutrición
Nutrición enteral
Nutrición parenteral
Diabetes
Guías
Recomendaciones
Revisión
Abstract
We selected controversial issues concerning nutritional support in diabetics from the international clinical guidelines, an Internet search, PubMed, and the Cochrane Library. Concerning oral diets, the glycemic index is a useful tool to select foods for the diet of patients with type 2 diabetes mellitus (DM) (A); a diet rich in monounsaturated fats in patients with type 2 DM can be an alternative to increase plasma highdensity lipoprotein cholesterol levels (A), but this strategy cannot be expected to improve glycemic control (B) and, to avoid weight gain, must substitute another source of energy rather than be used as a supplement (C). Concerning the ideal formula for enteral nutrition in patients with DM, formulas rich in monounsaturated fats produce a lower postprandial glycemic response than those rich in carbohydrates (A) but without modifying parameters of glycemic control in the long term (B). These formulas have been demonstrated to reduce insulin requirements only in cases of stress hyperglycemia in the intensive care unit (ICU) (C); the use of slow-release carbohydrates, such as fructose, is only effective if fiber is added (B) and the use of fiber alone has not been demonstrated to be effective (B). Concerning parenteral nutrition, intensive insulin therapy in patients undergoing parenteral nutrition in the surgical ICU can have a beneficial effect on mortality (B).
Key words:
Diet
Nutrition
Enteral nutrition
Parenteral nutrition
Diabetes
Guidelines
Recommendations
Review
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