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Intensive Versus Conventional Glycemic Control in Patients with Diabetes During Enteral Nutrition After Gastrectomy

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

This study compared intensive and conventional glycemic management strategies in diabetic patients receiving enteral nutrition after gastrectomy.

Methods

Diabetic patients (n = 212) who underwent gastrectomy between September 2006 and March 2014 were randomized to intensive glycemic (IG) management with continuous insulin infusion (target glucose 4.4–6.1 mmol/l (80–110 mg/dl)) or conventional glycemic (CG) management with intermittent bolus insulin (target glucose <11.1 mmol/l (<200 mg/dl)). Outcomes included blood glucose concentrations, insulin administration, and postoperative morbidity and mortality.

Results

Blood glucose levels were lower (5.4 ± 1.2 vs. 9.5 ± 1.8 mmol/l, P < 0.001) and mean insulin dose was higher (55 ± 15 vs.32 ± 16 units/day, P < 0.001) in the IG than in the CG group. Rates of severe hypoglycemia (7.5 vs. 0.9 %, P = 0.035) and achievement of target blood glucose (86.3 vs. 72.6 %, P = 0.023) were higher, while severe hyperglycemia rate was lower (1.9 vs. 11.3 %, P = 0.010), in the IG group. Surgical site infection rate was lower in the IG group (4.7 vs. 13.2 %, P < 0.030). Rates of other infective complications, bleeding, delayed gastric emptying, obstruction, hepatic dysfunction, renal dysfunction, and circulatory insufficiency were similar in the two groups.

Conclusions

Intensive glycemic control in diabetic patients receiving enteral nutrition after gastrectomy was associated with a lower surgical site infection rate but a higher hypoglycemia rate.

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Acknowledgments

This study was supported by the National Nature Science Foundation of China, Grant No. 81201955.

Conflict of Interest

All authors report no conflicts of interest.

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Author notes

    Authors and Affiliations

    1. Department of Laparoscopic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China

      Jiaxiang Yuan, Yaqing Si, Qun Wang & Xinsheng Shen

    2. Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, No. 1 East Jianshe Road, Zhengzhou, Henan, China

      Tao Liu, Xiefu Zhang, Yanwei Ye & Chunlin Zhao

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    1. Jiaxiang Yuan
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    2. Tao Liu
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    3. Xiefu Zhang
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    5. Yanwei Ye
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    6. Chunlin Zhao
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    7. Qun Wang
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    Corresponding author

    Correspondence to Xiefu Zhang.

    Additional information

    Jiaxiang Yuan and Tao Liu contributed equally to this work.

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    Yuan, J., Liu, T., Zhang, X. et al. Intensive Versus Conventional Glycemic Control in Patients with Diabetes During Enteral Nutrition After Gastrectomy. J Gastrointest Surg 19, 1553–1558 (2015). https://doi.org/10.1007/s11605-015-2871-7

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    • DOI: https://doi.org/10.1007/s11605-015-2871-7

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