Effective reduction in stress induced postoperative hyperglycemia in bariatric surgery by better carb loading.
Adult
Bariatric Surgery
Beverages
Citrulline
Diabetes Mellitus, Type 2
/ complications
Diet, Carbohydrate Loading
Enhanced Recovery After Surgery
Female
Fruit and Vegetable Juices
Humans
Hyperglycemia
/ prevention & control
Insulin Resistance
Male
Middle Aged
Polysaccharides
Postoperative Complications
/ prevention & control
Preoperative Care
/ methods
Stress, Physiological
/ drug effects
Enhanced recovery protocols
Hyperglycemia
Insulin management
Surgery
Journal
American journal of surgery
ISSN: 1879-1883
Titre abrégé: Am J Surg
Pays: United States
ID NLM: 0370473
Informations de publication
Date de publication:
03 2020
03 2020
Historique:
received:
29
06
2019
revised:
21
10
2019
accepted:
23
10
2019
pubmed:
24
11
2019
medline:
6
5
2020
entrez:
24
11
2019
Statut:
ppublish
Résumé
Preoperative carbohydrate loading is a recommended component of enhanced recovery protocols (ERP's), however the impact on postoperative stress-induced insulin resistance remains poorly studied in both diabetics and non-diabetics. Using our ERP, a preoperative grape juice group (Grape) was compared to the use of 25 g maltodextrin/3 g citrulline (G.E.D.™, SOF Health, LLC) for carbohydrate loading. The population included 171 patients (Grape n = 96; GED n = 75). Glycemic variability was significantly worse for the Grape group on POD 0 in both non-diabetic (70% vs 41%; p < 0.05) and diabetic patients (66% vs 34%; p < 0.05). Significantly more Grape patients required postoperative insulin regardless of diabetic status. Following bariatric surgery, the impact of stress induced hyperglycemia is primarily on POD 0 in non-diabetics whereas the effect extends into POD 1 for diabetics. Preoperative loading with G.E.D.™ versus grape juice is associated with a significantly lower rate of glycemic variation and postoperative insulin requirement, demonstrating that drink composition and treatment process reduces the severity of postoperative stress induced hyperglycemia in bariatric surgery patients.
Sections du résumé
BACKGROUND
Preoperative carbohydrate loading is a recommended component of enhanced recovery protocols (ERP's), however the impact on postoperative stress-induced insulin resistance remains poorly studied in both diabetics and non-diabetics.
METHODS
Using our ERP, a preoperative grape juice group (Grape) was compared to the use of 25 g maltodextrin/3 g citrulline (G.E.D.™, SOF Health, LLC) for carbohydrate loading.
RESULTS
The population included 171 patients (Grape n = 96; GED n = 75). Glycemic variability was significantly worse for the Grape group on POD 0 in both non-diabetic (70% vs 41%; p < 0.05) and diabetic patients (66% vs 34%; p < 0.05). Significantly more Grape patients required postoperative insulin regardless of diabetic status.
CONCLUSION
Following bariatric surgery, the impact of stress induced hyperglycemia is primarily on POD 0 in non-diabetics whereas the effect extends into POD 1 for diabetics. Preoperative loading with G.E.D.™ versus grape juice is associated with a significantly lower rate of glycemic variation and postoperative insulin requirement, demonstrating that drink composition and treatment process reduces the severity of postoperative stress induced hyperglycemia in bariatric surgery patients.
Identifiants
pubmed: 31757437
pii: S0002-9610(19)30897-9
doi: 10.1016/j.amjsurg.2019.10.042
pii:
doi:
Substances chimiques
Polysaccharides
0
Citrulline
29VT07BGDA
maltodextrin
7CVR7L4A2D
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
396-398Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest The authors have no commercial associations that might be a conflict of interest in relation to this article.