Effective reduction in stress induced postoperative hyperglycemia in bariatric surgery by better carb loading - 18/03/20
, Jesse Chou, Melissa Dusseljee, Stuart Verseman, Alain ElianAbstract |
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.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Use of preoperative maltodextrin/citrulline drink (G.E.D.™, SOFHealth, LLC) can lead to the reduction of hyperglycemic variability for both non-diabetics and diabetics even with the use of prophylactic dexamethasone. |
• | This benefit was also associated with a significant reduction in the need for insulin therapy regardless of diabetic status. |
• | These data represent the first direct evidence that a specific preoperative drink composition and treatment process reduces the rate and severity of postoperative stress induced hyperglycemia in bariatric surgery. |
Keywords : Hyperglycemia, Surgery, Insulin management, Enhanced recovery protocols
Plan
Vol 219 - N° 3
P. 396-398 - mars 2020 Retour au numéro
Article précédent
- Discussion on: Two open whipples a day: Excessive or efficient
- R.E. Simpson, M.L. Fennerty, K.F. Flick, C.L. Colgate, E.P. Ceppa, M.G. House, N.J. Zyromski, A. Nakeeb, C.M. Schmidt
- Discussion on: Effective reduction in stress induced postoperative hyperglycemia in hyperglycemia in bariatric surgery by better carb loading
- P. Knight, S. Verseman, A. Elian
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