Preoperative carbohydrate loading with individualized supplemental insulin in diabetic patients undergoing gastrointestinal surgery: A randomized trial

Abstract BackgroundPreoperative carbohydrate loading is used to improve patients’ comfort and recovery, but evidence remains limited in diabetic patients. We tested the feasibility of a preoperative carbohydrate drink with supplemental insulin in diabetic patients for gastrointestinal surgery.MethodsAdult patients with type 2 diabetes mellitus who were scheduled for major gastrointestinal surgery were randomized to carbohydrate group (carbohydrate drink with supplement insulin selectively) or control group (clinical routine management). The primary outcome was the time to first flatus after surgery. Among secondary outcomes, subjective feelings of thirsty, hunger and fatigue were assessed with the Visual Analogue Scale (scores range from 0 to 100, where 0 indicate no discomfort and 100 the most severe discomfort) before and after surgery.ResultsA total of 63 patients were randomized. Time to first flatus did not differ between groups (median [95% CI], 40 hours [30, 50] in control group vs. 43 hours [37, 48] in carbohydrate group, hazard ratio [95% CI], 1.24 [0.74, 2.07], P = 0.411). Both pre- and postoperative subjective feelings of discomfort were all significantly lower in carbohydrate group than in control group (median difference from − 50 to 0; all P < 0.05). Patients with carbohydrate drink developed less intraoperative hypotension (40.6% [13/30] vs. 16.1% [5/31], P = 0.031) and postoperative nausea and vomiting within 24 hours (31.3% [10/32] vs. 9.7% [3/31], P = 0.034).ConclusionIn diabetic patients undergoing gastrointestinal surgery, preoperative carbohydrate loading with supplemental insulin selectively did not affect gastrointestinal recovery; but it improved perioperative comfort, and reduced intraoperative hypotension and postoperative nausea and vomiting.Trial RegistrationClinicalTrial.gov, NCT03204344; Registered July 2, 2017, https://clinicaltrials.gov/ct2/show/NCT03204344.

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Preoperative carbohydrate loading and intraoperative goal-directed fluid therapy for elderly patients undergoing open gastrointestinal surgery: a prospective randomized controlled trial

BMC Anesthesiology ◽

10.1186/s12871-021-01377-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xia Liu ◽

Peng Zhang ◽

Meng Xue Liu ◽

Jun Li Ma ◽

Xin Chuan Wei ◽

...

Keyword(s):

Postoperative Complications ◽

Elderly Patients ◽

Fluid Therapy ◽

Controlled Trial ◽

Gastrointestinal Surgery ◽

Randomized Controlled ◽

Carbohydrate Loading ◽

Prospective Randomized Controlled Trial ◽

Preoperative Carbohydrate Loading ◽

Goal Directed Fluid Therapy

Abstract Background The effect of a combination of a goal-directed fluid protocol and preoperative carbohydrate loading on postoperative complications in elderly patients still remains unknown. Therefore, we designed this trial to evaluate the relative impact of preoperative carbohydrate loading and intraoperative goal-directed fluid therapy versus conventional fluid therapy (CFT) on clinical outcomes in elderly patients following gastrointestinal surgery. Methods This prospective randomized controlled trial with 120 patients over 65 years undergoing gastrointestinal surgery were randomized into a CFT group (n = 60) with traditional methods of fasting and water-deprivation, and a GDFT group (n = 60) with carbohydrate (200 ml) loading 2 h before surgery. The CFT group underwent routine monitoring during surgery, however, the GDFT group was conducted by a Vigileo/FloTrac monitor with cardiac index (CI), stroke volume variation (SVV), and mean arterial pressure (MAP). For all patients, demographic data, intraoperative parameters and postoperative outcomes were recorded. Results Patients in the GDFT group received significantly less crystalloids fluid (1111 ± 442.9 ml vs 1411 ± 412.6 ml; p < 0.001) and produced significantly less urine output (200 ml [150–300] vs 400 ml [290–500]; p < 0.001) as compared to the CFT group. Moreover, GDFT was associated with a shorter average time to first flatus (56 ± 14.1 h vs 64 ± 22.3 h; p = 0.002) and oral intake (72 ± 16.9 h vs 85 ± 26.8 h; p = 0.011), as well as a reduction in the rate of postoperative complications (15 (25.0%) vs 29 (48.3%) patients; p = 0.013). However, postoperative hospitalization or hospitalization expenses were similar between groups (p > 0.05). Conclusions Focused on elderly patients undergoing open gastrointestinal surgery, we found perioperative fluid optimisation may be associated with improvement of bowel function and a lower incidence of postoperative complications. Trial registration ChiCTR, ChiCTR1800018227. Registered 6 September 2018 - Retrospectively registered.

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Preoperative carbohydrate loading in diabetic patients within an enhanced recovery after surgery programme for colorectal surgery – Are there any ill effects?

Clinical Nutrition ESPEN ◽

10.1016/j.clnesp.2018.03.007 ◽

2018 ◽

Vol 25 ◽

pp. 167 ◽

Cited By ~ 2

Author(s):

Qin Yi Lee ◽

Hui Min Liu ◽

Yu Liang Lim ◽

Kwang Yeong How

Keyword(s):

Colorectal Surgery ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Diabetic Patients ◽

Carbohydrate Loading ◽

Preoperative Carbohydrate Loading

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Perioperative glycemic measures among non-fasting gynecologic oncology patients receiving carbohydrate loading in an enhanced recovery after surgery (ERAS) protocol

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2019-000991 ◽

2020 ◽

Vol 30 (4) ◽

pp. 533-540

Author(s):

Stephanie Alimena ◽

Michele Falzone ◽

Colleen M Feltmate ◽

Kia Prescott ◽

Leah Contrino Slattery ◽

...

Keyword(s):

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Gynecologic Oncology ◽

Infectious Complications ◽

Diabetic Patients ◽

Complication Rates ◽

Glucose Testing ◽

Carbohydrate Loading ◽

Increased Risk ◽

Preoperative Carbohydrate Loading

IntroductionPreoperative carbohydrate loading is an effective method to control postoperative insulin resistance. However, data are limited concerning the effects of carbohydrate loading on preoperative hyperglycemia and possible impacts on complication rates.MethodsA prospective cohort study was performed of patients enrolled in an enhanced recovery after surgery pathway at a single institution. All patients underwent laparotomy for known or suspected gynecologic malignancies. Patients who had been diagnosed with diabetes preoperatively and those prescribed total parenteral nutrition by their providers were excluded. Data regarding preoperative carbohydrate loading with a commercial maltodextrin beverage, preoperative glucose testing, postoperative day 1 glucose, insulin administration, and complications (all complications, infectious complications, and hyperglycemia-related complications) were collected. The primary endpoint of the study was the incidence of postoperative infectious complications, defined as superficial or deep wound infection, organ/space infection, urinary tract infection, pneumonia, sepsis, or septic shock.ResultsOf 415 patients, 76.9% had a preoperative glucose recorded. The mean age was 60.5±12.4 years (range 18–93). Of those with recorded glucose values, 30 patients (9.4%) had glucose ≥180 mg/dL, none of whom were actually given insulin preoperatively. Median preoperative glucose value was significantly increased after carbohydrate loading (122.0 mg/dL with carbohydrate loading vs 101.0 mg/dL without, U=3143, p=0.001); however, there was no relationship between carbohydrate loading and complications. There was a significantly increased risk of hyperglycemia-related complications with postoperative day 1 morning glucose values ≥140 mg/dL (OR 1.85, 95% CI 1.07 to 3.23; p=0.03). Otherwise, preoperative and postoperative hyperglycemia with glucose thresholds of ≥140 mg/dL or ≥180 mg/dL were not associated with increased risk of other types of complications.DiscussionCarbohydrate loading is associated with increased preoperative glucose values; however, this is not likely to be clinically significant as it does not have an impact on complication rates. Preoperative hyperglycemia is not a risk factor for postoperative complications in a carbohydrate-loaded population when known diabetic patients are excluded.PrecisWhile glucose increased with carbohydrate loading in non-diabetic patients, this was not associated with complications.

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