P-290: Nutritional supplementation and weight recovery in malnourished patients with insulin-treated diabetes in a low-resource setting

Introduction

Malnutrition associated with diabetes in low-resource settings presents major management challenges. Inappropriate dietary restriction may worsen outcomes. The role of nutritional supplementation alongside insulin therapy remains insufficiently described.

Objectives

To evaluate the impact of nutritional supplementation on weight gain and glycemic control in malnourished patients with diabetes when insulin is available.

Methods

We conducted a prospective observational study at Kivu Diabetes Center including four patients followed over 5 months. Patients were transitioned to a basal-bolus insulin regimen (Glardine insulin once per day and lispro insulin at each meal). Nutritional rehabilitation included daily supplementation with fortified corn-soy blend flour (CSB++) 250 mg per day. Patients were encouraged to consume freely available foods with appropriate insulin coverage. Fasting blood glucose was monitored daily.

Results

The mean age was 17.2 years and all were female. At admission, all patients presented with severe hyperglycemia (“HI”) in the setting of insulin deficiency, without urinary ketones. All had previously been treated with oral antidiabetic drugs (Metformine 500mg associated to Glibenclamide 5mg) with poor clinical response. Secondary amenorrhea was observed in 3 out of 4 patients following diabetes onset.

During follow-up, mean fasting blood glucose improved to 203.5 mg/dL vs HI. All patients experienced significant weight gain, moving from below the 3rd percentile to between the 3rd and 10th percentiles after 5 months (The average weight gain was 11.23 kg).

Conclusions

Nutritional supplementation combined with adequate insulin therapy improves both glycemic control and nutritional status in malnourished patients with diabetes. The high frequency of secondary amenorrhea suggests an additional endocrine impact requiring further investigation. These findings support promoting adequate caloric intake rather than restrictive diets in resource-limited settings when insulin is available.