World Journal of Surgery

, Volume 35, Issue 1, pp 85–92 | Cite as

Intensive Versus Conventional Insulin Therapy in Type 2 Diabetes Patients Undergoing D2 Gastrectomy for Gastric Cancer: A Randomized Controlled Trial

  • Shou-Gen Cao
  • Jian-An Ren
  • Bo Shen
  • Dong Chen
  • Yan-Bing ZhouEmail author
  • Jie-Shou Li



This study was to compare the effect of intensive insulin therapy (IIT) to conventional insulin therapy (CIT) on postoperative outcomes among type 2 diabetes mellitus (DM) patients who underwent D2 gastrectomy for gastric cancer.


We randomly assigned gastric cancer patients with type 2 DM who underwent radical gastrectomy to receive IIT (maintenance of blood glucose at a level between 4.4 and 6.1 mmol/l) with insulin infusion or CIT (maintenance of blood glucose at a level between 10 and 11.1 mmol/l) during the postoperative period.


Of the 179 eligible patients, 92 patients were assigned to receive IIT and 87 patients to receive CIT. Mean blood glucose concentrations were lower in the intensive group (IG) than in the conventional group (CG) (5.5 ± 0.8 vs. 9.9 ± 1.0 mmol/l, P < 0.001). Hypoglycemia occurred in 6 patients (6.5%) in the IG (P = 0.029) versus in 1 patient (1.1%) in the CG. Hospital mortality did not differ significantly between two groups (4.3% vs. 5.7%, P = 0.742). However, IIT significantly reduced morbidity (from 18.4 to 7.6%, P = 0.031). Also, IIT shortened the days to suture removal, postoperative hospital stay, and postoperative duration of antibiotic use. The HOMA-IR score was lower at all time points in IG. Moreover, IIT increased the postoperative HLA-DR expression on monocytes on postoperative days 3 and 5.


IIT significantly reduced short-term morbidity but not mortality among type 2 DM patients who underwent D2 gastrectomy for gastric cancer. Furthermore, a possible mechanism of suppression of the insulin resistance and improvement of HLA-DR expression may partially explain the benefits of IIT.


Gastric Cancer Hypoglycemia Diabetes Mellitus Patient Intensive Insulin Therapy Conventional Group 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This study was partially supported by the Health Science and Technology Development Project of Shandong (2005HZ024).

Conflict of interest

There is no potential and real conflict to any third party.


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Copyright information

© Société Internationale de Chirurgie 2010

Authors and Affiliations

  • Shou-Gen Cao
    • 1
  • Jian-An Ren
    • 1
  • Bo Shen
    • 1
  • Dong Chen
    • 2
  • Yan-Bing Zhou
    • 2
    Email author
  • Jie-Shou Li
    • 1
  1. 1.Medical School of Nanjing University, Institute of General Surgery, Jinling HospitalNanjingChina
  2. 2.Department of General SurgeryAffiliated Hospital of Medical College Qingdao UniversityQingdaoChina

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