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Time course change of the insulin requirements during the perioperative period in hepatectomy and pancreatectomy by using an artificial pancreas STG-55

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A Correction to this article was published on 28 April 2023

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Abstract

Introduction

To investigate changes in insulin requirements over time in patients who underwent hepatectomy and pancreatectomy with perioperative glycemic control by an artificial pancreas (STG-55).

Materials and methods

We included 56 patients (22 hepatectomies and 34 pancreatectomies) who were treated with an artificial pancreas in the perioperative period and investigated the differences in insulin requirements by organ and surgical procedure.

Results

The mean intraoperative blood glucose level and total insulin doses were higher in the hepatectomy group than in the pancreatectomy group. The dose of insulin infusion increased in hepatectomy, especially early in surgery, compared to pancreatectomy. In the hepatectomy group, there was a significant correlation between the total intraoperative insulin dose and Pringle time, and in all cases, there was a correlation with surgical time, bleeding volume, preoperative CPR, preoperative TDD, and weight.

Conclusions

Perioperative insulin requirements may be mainly dependent on the surgical procedure, invasiveness, and organ. Preoperative prediction of insulin requirements for each surgical procedure contributes to good perioperative glycemic control and improvement of postoperative outcomes.

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References

  1. Kazuhiro H. Latest clinically useful blood glucose control manual. Saitama: Medical Book Publishing; 2012. p. 89–95.

    Google Scholar 

  2. Quagliaro L, Piconi L, Assloni R. Intermittent high glucose enhances apoptosis related to oxidative stress in human umbilical vein endothelial cell: the role of protein kinase C and NAD (P) H-oxidase activation. Diabetes. 2003;52:2795–804.

    Article  CAS  PubMed  Google Scholar 

  3. van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001;345:1359–67.

    Article  PubMed  Google Scholar 

  4. Ata A, Lee J, Bestle S, Desemone J, Stain S. Postoperative hyperglycemia and surgical site infection in general surgery patients. Arch Surg. 2010;145:858–64.

    Article  PubMed  Google Scholar 

  5. The NICE-SUGAR Study Investigators. Hypoglycemia and risk of death in critically ill patients. N Engl J Med. 2012;367:1108–18.

    Article  Google Scholar 

  6. Lee A, Faddoul B, Sowan A, Johnson K, Silver K, Vaidya V. Computerisation of a paper-based intravenous insulin protocol reduces errors in a prospective crossover simulated tight glycemic control study. Intensive Crit Care Nursing. 2010;26:161–8.

    Article  Google Scholar 

  7. Yatabe T, Yamazaki R, Kitagawa H, Takehiro O, Koichi Y, Kazuhiro H, Masataka Y. The evaluation of the ability of closed-loop glycemic control device to maintain the blood glucose concentration in intensive care unit patients. Crit Care Med. 2011;39:575–8.

    Article  CAS  PubMed  Google Scholar 

  8. Watanabe K, Maeda H, Shojima S, Takeda M, Nakatou T, Fushimi T, Kojima T, Nikuma T, Akazai Y, Mimura T. Perioperative blood glucose for the third hepatectomy. A case of type 1 diabetes with a favorable course using an artificial pancreas (STG-55) for management. Diabetes. 2018;61(9):593–9.

    Google Scholar 

  9. Okabayashi T, Nishimori I, Maeda H, Yamashita K, Yatabe T, Hanazaki K. Effect of intensive insulin therapy using a closed-loop glycemic control system in hepatic resection patients. Diabetes Care. 2009;32:1425–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Hanazaki K, Kitagawa H, Yatabe T, Munekage M, Dabanaka K, Takezaki Y, Tsukamoto Y, Asano T, Kinoshita Y, Namikawa T. Perioperative intensive insulin therapy using an artificial endocrine pancreas with closed-loop glycemic control system: the effects of no hypoglycemia. Am J Surg. 2014;207(6):935–41.

    Article  PubMed  Google Scholar 

  11. Hanazaki K, Munekage M, Kitagawa H, Yatabe T, Munekage E, Shiga M, Maeda H, Namikawa T. Current topics in glycemic control by wearable artificial pancreas or bedside artificial pancreas with closed-loop system. J Artif Organs. 2016;19:209–18.

    Article  CAS  PubMed  Google Scholar 

  12. Hanazaki K, Maeda H, Okabayashi T. Relationship between perioperative glycemic control and postoperative infections. World J Gastroenterol. 2009;15:4122–5.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Okabayashi T, Maeda H, Zhao-Li SZI, Montgomery RA, Nishimori I, Hanazaki K. Perioperative insulin therapy using a closed-loop artificial endocrine pancreas after hepatic resection. World J Gastroenterol. 2009;15(33):4116–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Sawa A, Kimura K, Morikane K, Harihara Y. Examination of SSI risk factors in the field of gastrointestinal surgery in Japan based on JHAIS data. J Jpn Dept Surg Infect Dis. 2013;10(1):43–52.

    Google Scholar 

  15. Murakami M, Junzo Shimizu J, Koga M, Kawabata R, Noura S, Hasegawa J. Examination of postoperative hyperglycemia and surgical site infection in hepatobiliary and pancreatic surgery. J Jpn Soc Surg Infect Dis. 2015;12(6):657–61.

    Google Scholar 

  16. Maeda H, Okabayashi T, Yatabe T, Yamashita K, Hanazaki K. Perioperative intensive insulin therapy using artificial endocrine pancreas in patients undergoing pancreatectomy. World J Gastroenterol. 2009;15(33):4111–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Obayashi T, Nishimori I, Yamashita K, Sugimoto T, Maeda H, Yatabe T, Kohsaki T, Kobayashi M, Hanazaki K. Continuous postoperative blood glucose monitoring and control by artificial pancreas in patients having pancreatic resection. Arch Surg. 2009;144(10):933–7.

    Article  Google Scholar 

  18. Pringle JH. Note on the arrest of hepatic hemorrhage due to trauma. Ann Surg. 1908;48:541.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Figueras J, Llado L, Ruiz D, Ramos E, Busquets J, Rafecas A, Torras J, Fabregat J. Complete versus selective portal triad clamping for minor liver resections: a prospective randomized trial. Ann Surg. 2005;241:582–90.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Ishizaki Y, Yoshimoto J, Miwa K, Sugo H, Kawasaki S. Safety of prolonged intermittent Pringle maneuver during hepatic resection. Arch Surg. 2006;141:649–53.

    Article  PubMed  Google Scholar 

  21. Belghiti J, Noun R, Malafosse R, Jagot P, Sauvanet A, Pierangeli A, Marty J, Farges O. Continuous versus intermittent portal triad clamping for liver resection: a controlled study. Ann Surg. 1999;229:369–75.

    Article  CAS  PubMed Central  Google Scholar 

  22. Maeda H, Okabayashi T, Nishimori I, Yamashita K, Sugimoto T, Hanazaki K. Hyperglycemia during hepatic resection: continuous monitoring of blood glucose concentration. Am J Surg. 2010;199:8–13.

    Article  CAS  PubMed  Google Scholar 

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Funding

Sanofi K.K., Eli Lilly Japan, Abbott Japan, Novo Nordisk Pharma, Dainippon Sumitomo Pharma.

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Authors and Affiliations

  1. Department of Internal Medicine, Diabetes Center, Okayama Saiseikai General Hospital, 2-25 Kokutaicho, Kita-Ku, Okayama, 700-8511, Japan

    Sanae Teshigawara, Atsuhito Tone, Yusuke Imai, Toshihisa Tahara, Mayumi Senoo, Satoko Watanabe, Mitsuhiro Kaneto, Yasuyuki Shimomura & Tatsuaki Nakatou

  2. Department of Diabetology and Metabolism, National Hospital Organization, Okayama Medical Center, Okayama, Japan

    Akihiro Katayama

  3. Department of Surgery, Okayama Saiseikai General Hospital, Okayama, Japan

    Chiaki Yagi, Hiroki Kajioka, Toru Kojima & Takefumi Niguma

Authors
  1. Sanae Teshigawara
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  2. Atsuhito Tone
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  3. Akihiro Katayama
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  4. Yusuke Imai
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  5. Toshihisa Tahara
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  6. Mayumi Senoo
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  7. Satoko Watanabe
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  8. Mitsuhiro Kaneto
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  9. Yasuyuki Shimomura
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  10. Chiaki Yagi
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  11. Hiroki Kajioka
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  12. Toru Kojima
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  13. Takefumi Niguma
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  14. Tatsuaki Nakatou
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Corresponding author

Correspondence to Atsuhito Tone.

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Conflict of interest

Author Atsuhito T. received lecture fees from Sanofi, Eli Lilly, and Abbott. Author Tatsuaki N. received lecture fees from Eli Lilly Japan, Novo Nordisk Pharma, and Sumitomo Dainippon Pharma. Other authors declare that they have no conflict of interest associated with this research.

Ethical approval and consent to participate

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. This study was approved by the ethics committee of Okayama Saiseikai General Hospital (approval no. 190303; approval date February 25th, 2019). We did not receive informed consent, but we provided the participants with the opportunity to refuse by publishing the Opt Out document.

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Teshigawara, S., Tone, A., Katayama, A. et al. Time course change of the insulin requirements during the perioperative period in hepatectomy and pancreatectomy by using an artificial pancreas STG-55. Diabetol Int 14, 262–270 (2023). https://doi.org/10.1007/s13340-023-00623-3

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  • DOI: https://doi.org/10.1007/s13340-023-00623-3

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