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

January 4, 2022

Background:
Preoperative carbohydrate drink is used to improve patients’ comfort and recovery, but evidence remains limited in diabetic patients. Herein we investigated the effects of preoperative carbohydrate loading with individualized supplemental insulin regimen in diabetic patients undergoing gastrointestinal surgery.
Methods:
A total of 63 adult patients with type 2 diabetes mellitus undergoing major gastrointestinal surgery were randomized to receive either carbohydrate loading with individualized supplemental insulin (Carbohydrate group) or routine management (Control group). The primary outcome was 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. Adverse events were monitored until 24 h after surgery.
Results:
All patients were included in the intention-to-treat analysis. Time to first flatus did not differ between groups (median 41 h [IQR 18–69] in the Control group vs. 43 h [27–54] in the Carbohydrate group; hazard ratio 1.24 [95% CI 0.74–2.07]; P = 0.411). The VAS score of preoperative subject feeling of thirsty (median difference 33 [95% CI -50 to 15], P < 0.001), hunger ( 25 [-40 to 10], P < 0.001), and fatigue ( 5 [-30 to 0], P = 0.004), as well as postoperative subject feeling of thirsty ( 50 [-60 to 30], P < 0.001), hunger ( 20 [-40 to 0], P = 0.003), and fatigue (0 [-20 to 0], P = 0.020) were all significantly lower in the Carbohydrate group than in the Control group. Intraoperative hypotension (40.6% [13/32] vs. 16.1% [5/31], P = 0.031) and postoperative nausea and vomiting within 24 h (31.3% [10/32] vs. 9.7% [3/31], P = 0.034) occurred less in patients given carbohydrate drink. Conclusion:
n diabetic patients undergoing gastrointestinal surgery, preoperative carbohydrate loading with individualized supplemental insulin did not promote gastrointestinal recovery but improved perioperative well- being.