Oleh Admin Kalbe Medical pada September 07, 2017 07:30

Manfaat Pemberian Nutrisi Enteral pada Pasien Diabetes

Kontrol glikemik yang ketat, salah satunya dengan komposisi diet primer, memiliki dampak yang positif terhadap outcome klinis jangka panjang pada pasien diabetes dengan memperlambat progresivitas komplikasi yang dikaitkan dengan diabetes. Beberapa pasien diabetes membutuhkan suplementasi tambahan nutrisi yang disebabkan oleh asupan nutrisi yang kurang atau undernutrition. Selain itu, terdapat peningkatan jumlah pasien yang mendapatkan nutrisi enteral di rumah, termasuk di antaranya yang mendapatkan nutrisi standar dengan komposisi tinggi karbohidrat (KH), rendah lemak, dan rendah serat. Nutrisi standar ini umumnya memiliki jenis KH yang cepat diserap, sehingga menyebabkan terjadinya hiperglikemia pada pasien diabetes.

Pada sebuah tinjauan sistematis, nutrisi enteral khusus diabetes yang memiliki kandungan MUFA (monounsaturated fatty acid) dan fruktosa dapat memberikan efek kadar glukosa darah setelah makan dan kadar glukosa dibawah kurva (AUC) yang lebih rendah secara bermakna jika dibandingkan dengan formula standar. Akan tetapi, belum terdapat tatalaksana khusus pada pasien diabetes yang memiliki risiko malnutrisi yang membutuhkan dukungan nutrisi. Beberapa dekade terakhir, muncul argumentasi terkait akan jumlah penggunaan MUFA untuk memperbaiki profil nutrisi pada nutrisi enteral khusus diabetes dengan menurunkan kadar KH dan meningkatkan kadar MUFA.

Pada sebuah penelitian, suplementasi nutrisi enteral tinggi MUFA dapat memperbaiki profil HbA1c dan kadar albumin. Akan tetapi, pada studi lainnya, pemberian nutrisi enteral khusus diabetes dengan persentase distribusi kalori lemak yang lebih rendah, memberikan perbaikan pada parameter berat badan dan kadar protein tanpa menimbulkan gangguan metabolik. Selain itu, pada pasien diabetes lanjut usia penting adanya tatalaksana untuk menentukan kandungan MUFA yang ideal yang terkandung di dalam nutrisi khusus diabetes untuk memperbaiki parameter metabolik dan juga berat badan.

Sebuah penelitian terbaru yang dilakukan secara acak membandingkan efek dari pemberian nutrisi khusus diabetes yang memiliki kandungan tinggi MUFA pada 2 dosis yang berbeda selama 10 minggu terhadap 27 pasien lanjut usia (>65 tahun) dengan diabetes melitus tipe 2 dengan kehilangan berat badan >5% pada 3 bulan terakhir. Pasien diacak dan dibagi menjadi 2 kelompok dan menerima 2 saji (kelompok 1) atau 3 saji (kelompok 2) nutrisi enteral khusus diabetes tinggi MUFA. Hasilnya terdapat penurunan kadar HbA1c pada kedua kelompok secara bermakna jika dibandingkan dengan basal (p<0,05), peningkatan kadar albumin dan prealbumin secara bermakna terlihat pada kedua kelompok jika dibandingkan dengan basal (p<0,05), dan perbaikan berat badan secara bermakna terjadi pada kedua kelompok jika dibandingkan dengan basal (p<0,05). Tidak terdapat efek samping, seperti mual, muntah, nyeri abdomen, dan cramp yang dilaporkan, serta tidak terdapat drop-out akibat intoleransi. (LAI)
    
Simpulan:
Berdasarkan studi tersebut, pemberian nutrisi enteral dengan kandungan tinggi MUFA dapat memperbaiki HbA1c dan status nutrisi. Perbaikan terlihat lebih baik pada kelompok dengan 3 saji per hari jika dibandingkan dengan 2 saji per hari, akan tetapi tidak bermakna secara statistik.

Image : Ilustrasi
Referensi:
1.de Luis DA, Izaola O, de la Fuente B, Terroba MC, Cuellar L, Cabezas G. A randomized clinical trial with two doses of an enteral diabetes-specific suplements in elderly patients with diabetes mellitus type 2. Eur Rev Med Pharmacol Sci. 2013;17(12):1626-30.
2.Pohl M, Mayr P, Mertl-Roetzer M, Lauster F, Haslbeck M, Hipper B, et al. Glycemic control in patients with type 2 diabetes mellitus with a disease-specific enteral formula: Stage II of a randomized, controlled multicenter trial. JPEN J Parenter Enteral Nutr. 2009;33(1):37-49.

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