Diabetes UK Position Statements Glycaemic management during the inpatient enteral feeding of people with stroke and diabetes A. W. Roberts 1 , and S. Penfold 2 , on behalf of the Joint British Diabetes Societies (JBDS) for Inpatient Care* 1 Cardiff and Vale University Health Board, Cardiff, UK and 2 Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK Accepted 12 May 2018 Abstract This paper is an abridged and modified version of guidelines produced by the Joint British Diabetes Societies for inpatient care on glycaemic management during the enteral feeding of people with stroke and diabetes. These were revised in 2017 and have been adapted specifically for Diabetic Medicine. The full version can be found at: www.diabetes.org.uk/joint- british-diabetes-society or https://abcd.care/joint-british-diabetes-societies-jbds-inpatient-care-group. Many people have both diabetes and an acute stroke, and a stanv dard approach to the management of people with stroke is the provision of adequate nutrition. Frequently, this involves a period of enteral feeding if there is impaired ability to swallow food safely. There is currently considerable variability in the management of people with diabetes fed enterally after a stroke, and the evidence base guiding diabetes management in this clinical situation is very weak, although poor glycaemic outcomes in people receiving enteral feeding after stroke may worsen recovery and cause harm. The aim of this document is to provide sensible clinical guidance in this area, written by a multidisciplinary team; this guideline had input from diabetes specialist nurses, diabetologists, dietitians, stroke physicians and pharmacists with expertise in this area, and from UK professional organizations. It is aimed at multidisciplinary teams managing people with stroke and diabetes who require enteral feeding. We recognize that there is limited clinical evidence in this area. Diabet. Med. 35, 1027–1036 (2018) Introduction A diagnosis of diabetes at least doubles the risk of stroke [1]; thus, a considerable proportion of those presenting to hospital with acute stroke will have Type 2 diabetes and, less commonly, Type 1 diabetes. An estimated 150 000 people experience stroke in the UK every year [2], and they occupy ~20% of all acute hospital beds and 25% of long-term beds [3]. The purpose of this guideline is to assist UK diabetes teams, general physicians, stroke physicians, nursing staff, junior doctors and other healthcare professionals in the management of enteral feeding in people with diabetes who have had a stroke. The majority of feeding in these circumstances is likely to be continuous enteral feeding with a defined rest period, but some units also use bolus feeding regimens. All those who present with stroke should have capillary blood glucose checked on admission to hospital, as hyper- glycaemia in people with stroke is common and associated with worse outcomes [4]. Lowering blood glucose in people with diabetes during acute stroke has not been shown to significantly improve outcomes [5–7], although glucose- lowering with insulin has been shown to limit cerebral infarct size in animal studies [8]. Hyperglycaemia is likely to be encountered if an individual with diabetes is to be fed via the enteral route. The opinion of the present writing group is that optimizing diabetes control during enteral feeding will improve inpatient experience, and potentially clinical out- comes, for people with diabetes who have had a stroke. This guideline concentrates solely on control of blood glucose during enteral feeding in people with stroke. Basic principles may be extrapolated, with the input of local diabetes teams, into other clinical situations such as percu- taneous endoscopic gastrostomy feeding, parenteral feeding, and enteral feeding in other neurological conditions. A discussion on the relative benefits of tight glucose control on outcomes following stroke per se in people with diabetes is outside the remit of the present document [9]. In people who are hospitalized with stroke and fed by the enteral route, the management of hyperglycaemia should be balanced against the risks of hypoglycaemia. Hypoglycaemia Correspondence to: Aled W. Roberts. E-mail: aled.roberts2@wales.nhs.uk *Members of the Joint British Diabetes Societies (JBDS) for Inpatient Care are given under the heading Collaborators. ª 2018 Diabetes UK 1027 DIABETICMedicine DOI: 10.1111/dme.13678