The impact of preoperative carbohydrate loading on patients with type II diabetes in an enhanced recovery after surgery protocol

Am J Surg. 2020 Oct;220(4):999-1003. doi: 10.1016/j.amjsurg.2020.03.032. Epub 2020 Mar 30.

Abstract

Background: We aimed to determine the effects of preoperative carbohydrate-loading (CHO) as part of an enhanced recovery after surgery (ERAS) pathway on patients with/without type II diabetes (DMII).

Methods: Retrospective review of ERAS patients with CHO, including 80 with DMII, 275 without DMII in addition to 89 patients with DMII from the previous (non-ERAS) year. Outcomes included glucose-levels, insulin requirements, and complications. Logistic regression was used to determine the association of any complication with perioperative glucose control variables.

Results: Among ERAS versus non-ERAS patients with DMII, there were significant differences in median preoperative (142 mg/dL versus 129.5 mg/dL, p = 0.017) and postoperative day-1 glucose levels (152 mg/dL, versus 137.5 mg/dL, p = 0.004). There were no differences in insulin requirements, hypoglycemic episodes, or complications. Complications were not associated with Hgb-A1C%, home DMII-medications, or preoperative glucose measurement on logistic regression.

Conclusions: Patients with DMII tolerated CHO without increasing insulin requirements or substantially affecting glucose levels or complications.

Keywords: Carbohydrate loading; Diabetes; ERAS.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Glucose / metabolism*
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / complications*
  • Diet, Carbohydrate Loading / methods*
  • Dietary Carbohydrates / administration & dosage*
  • Digestive System Surgical Procedures / methods*
  • Enhanced Recovery After Surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Postoperative Complications / epidemiology
  • Postoperative Period
  • Preoperative Care / methods*
  • Prognosis
  • Retrospective Studies
  • United States / epidemiology
  • Young Adult

Substances

  • Blood Glucose
  • Dietary Carbohydrates