The Quality of Preoperative Glycemic Control Predicts Insulin Sensitivity During Major Upper Abdominal Surgery: A Case-Control Study

Keisuke Omiya; Hiroaki Sato; Tamaki Sato; Abdulwahaab Nooh; Bon-Wook Koo; Stanislas Kandelman; Thomas Schricker

doi:10.1097/AS9.0000000000000234

The Quality of Preoperative Glycemic Control Predicts Insulin Sensitivity During Major Upper Abdominal Surgery: A Case-Control Study

Ann Surg Open. 2023 Jan 12;4(1):e234. doi: 10.1097/AS9.0000000000000234. eCollection 2023 Mar.

Authors

Keisuke Omiya¹, Hiroaki Sato¹, Tamaki Sato¹, Abdulwahaab Nooh¹, Bon-Wook Koo¹, Stanislas Kandelman¹, Thomas Schricker¹

Affiliation

¹ From the Department of Anesthesia, McGill University Health Centre Glen Site, Royal Victoria Hospital, Montreal, QC, Canada.

Abstract

Objective: To examine the association of the quality of preoperative glycemic control and insulin sensitivity during major upper abdominal surgery.

Background: In cardiac surgery, glycated hemoglobin A_1c (HbA_1c), an indicator of glycemic control during the preceding 3 months, correlated with intraoperative insulin sensitivity. Furthermore, insulin resistance showed a significant association with adverse clinical outcomes.

Methods: This study is a post hoc exploratory analysis of a randomized controlled trial in patients undergoing elective hepatectomy and receiving the hyperinsulinemic-normoglycemic clamp (HNC) as a potential intervention to reduce surgical site infections (ClinicalTrials.gov NCT01528189). Immediately before skin incision, the HNC was initiated by infusing insulin at the rate of 2 mU/kg/min. Dextrose was administered at rates titrated to maintain normoglycemia (4.0-6.0 mmol/L). The average of 3 consecutive dextrose infusion rates during steady state was used as a measure of insulin sensitivity. Primary outcome was the relationship between preoperative HbA_1c and insulin sensitivity during surgery. Secondary outcomes were the associations of insulin sensitivity with the patient's body mass index (BMI) and postoperative morbidity.

Results: Thirty-four patients were studied. HbA_1c (Y = -0.52X + 4.8, P < 0.001, R² = 0.29), BMI (Y = -0.12X + 5.0, P < 0.001, R² = 0.43) showed negative correlations with insulin sensitivity. The odds ratio of postoperative complications within 30 days of surgery for every increase in insulin sensitivity by 1 mg/kg/min was 0.22 (95% confidential interval, 0.06-0.59; P = 0.009).

Conclusions: We demonstrate significant associations of the quality of preoperative glycemic control and body mass index with insulin sensitivity during hepatectomy. The degree of insulin resistance correlated with postoperative morbidity.

Keywords: body mass index; diabetes; glycated hemoglobin A1c; intraoperative insulin sensitivity; postoperative morbidity.

Associated data

ClinicalTrials.gov/NCT01528189