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The Use of a Pre-operative Carbohydrate Drink in Patients with Diabetes Mellitus: A Prospective, Non-inferiority, Cohort Study

World Journal of Surgery volume 42, pages 1965–1970 (2018)Cite this article

Abstract

Background

Pre-operative fasting leads to insulin resistance and increased metabolic stress in non-diabetic patients. Consumption of a carbohydrate drink may alleviate these deleterious effects. Patients with diabetes mellitus represent over 15% of the surgical population, yet concerns over hyperglycemia and aspiration have excluded patients with diabetes mellitus from studies assessing the utility of pre-operative carbohydrate drinks.

Objective

To assess for a clinically significant increase in pre-operative blood glucose concentration (defined as >2 mmol/L) in patients with diabetes consuming a pre-operative carbohydrate drink.

Methods

A prospective observational non-inferiority cohort study of 106 subjects with diabetes mellitus was undertaken to assess the effect of consuming a pre-operative carbohydrate drink in surgical patients. All patients with diabetes mellitus undergoing surgery (including but not limited to cardiac, neurologic, urologic, and general surgical procedures) were enrolled. Subjects were instructed to consume two carbohydrate-rich drinks, one before sleeping the evening prior to surgery and another on the day of surgery.

Results

In total, 43% of subjects were fully compliant with the pre-operative carbohydrate drink regimen. There were no significant differences between the fully compliant and non-compliant subjects with respect to baseline characteristics. Consumption of a pre-operative carbohydrate drink was determined to be non-inferior to fasting in terms of pre-operative blood glucose concentration (absolute difference 0.23 mmol/L, 95% CI: −1.00 to 1.45 mmol/L, p non-inferiority < 0.01). Neither group was found to be superior in terms of pre-operative blood glucose concentration, hyperglycemia, or length of stay.

Conclusions

These findings function as a step toward ensuring pre-operative carbohydrate drinks are safe in patients with diabetes undergoing surgery.

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References

  1. Roberts RB, Shirely MA (1974) Reducing the risk of acid aspiration during cesarean section. Anesth Analg 53(6):859–868

    Article  PubMed  CAS  Google Scholar 

  2. Awad S, Constantin-Teodosiu D, Macdonald IA, Lobo DN (2009) Short-term starvation and mitochondrial dysfunction—a possible mechanism leading to postoperative insulin resistance. Clin Nutr 28(5):497–509. https://doi.org/10.1016/j.clnu.2009.04.014

    Article  PubMed  CAS  Google Scholar 

  3. Brady M, Kinn S, Stuart P (2003) Preoperative fasting for adults to prevent perioperative complications. Cochrane Database Syst Rev 4:CD004423. https://doi.org/10.1007/bf03077179

    Article  Google Scholar 

  4. Awad S, Varadhan KK, Ljungqvist O, Lobo DN (2013) A meta-analysis of randomised controlled trials on preoperative oral carbohydrate treatment in elective surgery. Clin Nutr 32(1):34–44. https://doi.org/10.1016/j.clnu.2012.10.011

    Article  PubMed  CAS  Google Scholar 

  5. Liu VX, Rosas E, Hwang J et al (2017) Enhanced recovery after surgery program implementation in 2 surgical populations in an integrated health care delivery system. JAMA Surg 56(10):e171032. https://doi.org/10.1001/jamasurg.2017.1032

    Article  Google Scholar 

  6. Shaw AD, Bagshaw SM, Goldstein SL et al (2012) Major complications, mortality, and resource utilization after open abdominal surgery: 0.9% saline compared to plasma-lyte. Ann Surg 255(5):821–829. https://doi.org/10.1097/SLA.0b013e31825074f5

    Article  PubMed  Google Scholar 

  7. Frisch A, Chandra P, Smiley D et al (2010) Prevalence and clinical outcome of hyperglycemia in the perioperative period in noncardiac surgery. Diabetes Care 33(8):1783–1788. https://doi.org/10.2337/dc10-0304

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  8. Albalawi Z, Laffin M, Gramlich L, Senior P, McAlister FA (2017) Enhanced recovery after surgery (ERAS®) in individuals with diabetes: a systematic review. World J Surg. https://doi.org/10.1007/s00268-017-3982-y

    PubMed  Article  Google Scholar 

  9. Amer MA, Smith MD, Herbison GP, Plank LD, McCall JL (2017) Network meta-analysis of the effect of preoperative carbohydrate loading on recovery after elective surgery. Br J Surg 104(3):187–197. https://doi.org/10.1002/bjs.10408

    Article  PubMed  CAS  Google Scholar 

  10. Ganesh SP, Pietrobon R, Cecilio WA, Pan D, Lightdale N, Nunley JA (2005) The impact of diabetes on patient outcomes after ankle fracture. J Bone Jt Surg Am 87(8):1712–1718

    Google Scholar 

  11. Martin ET, Kaye KS, Knott C et al (2016) Diabetes and risk of surgical site infection: a systematic review and meta-analysis. Infect Control Hosp Epidemiol 37(1):88–99. https://doi.org/10.1017/ice.2015.249

    Article  PubMed  Google Scholar 

  12. Dhatariya K, Levy N, Kilvert A et al (2012) NHS diabetes guideline for the perioperative management of the adult patient with diabetes. Diabetic 29(4):420–433. https://doi.org/10.1111/j.1464-5491.2012.03582.x

    Article  CAS  Google Scholar 

  13. Gustafsson UO, Nygren J, Thorell A et al (2008) Pre-operative carbohydrate loading may be used in type 2 diabetes patients. Acta Anaesthesiol Scand 52(7):946–951. https://doi.org/10.1111/j.1399-6576.2008.01599.x

    Article  PubMed  CAS  Google Scholar 

  14. King JTJ, Goulet JL, Perkal MF, Rosenthal RA (2011) Glycemic control and infections in patients with diabetes undergoing noncardiac surgery. Ann Surg 253(1):158–165. https://doi.org/10.1097/SLA.0b013e3181f9bb3a

    Article  PubMed  Google Scholar 

  15. Critique SI (2010) Postoperative hyperglycemia and surgical site infection in general surgery patients. Arch Surg 145(9):858–864

    Article  Google Scholar 

  16. Kwon S, Thompson R, Dellinger P, Yanez D, Farrohki E, Flum D (2013) Importance of perioperative glycemic control in general surgery: a report from the surgical care and outcomes assessment program. Ann Surg 257(1):8–14. https://doi.org/10.1097/SLA.0b013e31827b6bbc

    Article  PubMed  PubMed Central  Google Scholar 

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Affiliations

  1. Department of Surgery, 2D, Walter C Mackenzie Health Sciences Centre, University of Alberta, 8440 - 112 Street, Edmonton, AB, T6G 2R3, Canada

    Michael R. Laffin, Rondald Brisebois & Haili Wang

  2. Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada

    Shuai Li

  3. Division of Endocrinology, University of Alberta, Edmonton, AB, Canada

    Peter A. Senior

Authors
  1. Michael R. Laffin
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  2. Shuai Li
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  3. Rondald Brisebois
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  4. Peter A. Senior
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  5. Haili Wang
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Correspondence to Michael R. Laffin.

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Laffin, M.R., Li, S., Brisebois, R. et al. The Use of a Pre-operative Carbohydrate Drink in Patients with Diabetes Mellitus: A Prospective, Non-inferiority, Cohort Study. World J Surg 42, 1965–1970 (2018). https://doi.org/10.1007/s00268-017-4413-9

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  • DOI: https://doi.org/10.1007/s00268-017-4413-9