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Teshigawara S, Tone A, Katayama A, Imai Y, Tahara T, Senoo M, Watanabe S, Kaneto M, Shimomura Y, Yagi C, Kajioka H, Kojima T, Niguma T, Nakatou T. Time course change of the insulin requirements during the perioperative period in hepatectomy and pancreatectomy by using an artificial pancreas STG-55. Diabetol Int 2023; 14:262-270. [PMID: 37397907 PMCID: PMC10307749 DOI: 10.1007/s13340-023-00623-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 03/07/2023] [Indexed: 04/05/2023]
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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Affiliation(s)
- Sanae Teshigawara
- Department of Internal Medicine, Diabetes Center, Okayama Saiseikai General Hospital, 2-25 Kokutaicho, Kita-Ku, Okayama, 700-8511 Japan
| | - Atsuhito Tone
- Department of Internal Medicine, Diabetes Center, Okayama Saiseikai General Hospital, 2-25 Kokutaicho, Kita-Ku, Okayama, 700-8511 Japan
| | - Akihiro Katayama
- Department of Diabetology and Metabolism, National Hospital Organization, Okayama Medical Center, Okayama, Japan
| | - Yusuke Imai
- Department of Internal Medicine, Diabetes Center, Okayama Saiseikai General Hospital, 2-25 Kokutaicho, Kita-Ku, Okayama, 700-8511 Japan
| | - Toshihisa Tahara
- Department of Internal Medicine, Diabetes Center, Okayama Saiseikai General Hospital, 2-25 Kokutaicho, Kita-Ku, Okayama, 700-8511 Japan
| | - Mayumi Senoo
- Department of Internal Medicine, Diabetes Center, Okayama Saiseikai General Hospital, 2-25 Kokutaicho, Kita-Ku, Okayama, 700-8511 Japan
| | - Satoko Watanabe
- Department of Internal Medicine, Diabetes Center, Okayama Saiseikai General Hospital, 2-25 Kokutaicho, Kita-Ku, Okayama, 700-8511 Japan
| | - Mitsuhiro Kaneto
- Department of Internal Medicine, Diabetes Center, Okayama Saiseikai General Hospital, 2-25 Kokutaicho, Kita-Ku, Okayama, 700-8511 Japan
| | - Yasuyuki Shimomura
- Department of Internal Medicine, Diabetes Center, Okayama Saiseikai General Hospital, 2-25 Kokutaicho, Kita-Ku, Okayama, 700-8511 Japan
| | - Chiaki Yagi
- Department of Surgery, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Hiroki Kajioka
- Department of Surgery, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Toru Kojima
- Department of Surgery, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Takefumi Niguma
- Department of Surgery, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Tatsuaki Nakatou
- Department of Internal Medicine, Diabetes Center, Okayama Saiseikai General Hospital, 2-25 Kokutaicho, Kita-Ku, Okayama, 700-8511 Japan
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Okazaki M, Hayashi H, Gabata R, Ohbatake Y, Shinbashi H, Nakanuma S, Makino I, Tajima H, Takamura H, Ohta T. Analysis of perioperative glucose metabolism using an artificial pancreas. Artif Organs 2021; 45:998-1005. [PMID: 33819346 DOI: 10.1111/aor.13962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 12/24/2022]
Abstract
Hyperglycemia associated with insulin resistance is common in surgical patients with and without diabetes and is associated with poor surgical outcomes. Several studies have recently shown that a closed-loop blood glucose monitoring system in the form of an artificial pancreas is safe and effective for surgical patients. In this study, we analyzed the risk factors for insulin resistance in patients using an artificial pancreas. We investigated 109 patients who underwent surgical management by an artificial pancreas for 24 hours from the start of surgery during either major hepatectomy (MH), defined as resection of more than two liver segments, or pancreaticoduodenectomy (PD). The target glucose range was from 80 to 110 mg/dL using an artificial pancreas. We analyzed the risk factors for and predictors of a high insulin dose, including sarcopenia markers, according to the median 24-hour total insulin infusion. The median total insulin dose and glycemic control rate (GCR), which is the rate of achieving the target blood glucose range, per 24 hours were 78.0 IU and 30.4% in the MH group and 82.6 IU and 23.5% in the PD group, respectively. The muscle volume was the only independent factor in the high-dose subgroup, and the GCR was significantly lower in the high-dose subgroup despite a high insulin dose in both the MH and PD groups. The results of this study suggest that preoperative sarcopenia is closely associated with insulin resistance in the perioperative period. Clinicians must effectively manage sarcopenia, which may result in improved perioperative glycemic control and reduced postoperative complications.
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Affiliation(s)
- Mitsuyoshi Okazaki
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Kanazawa, Japan
| | - Hironori Hayashi
- Department of Surgery, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Ryousuke Gabata
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Kanazawa, Japan
| | - Yoshinao Ohbatake
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Kanazawa, Japan
| | - Hiroyuki Shinbashi
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Kanazawa, Japan
| | - Shinichi Nakanuma
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Kanazawa, Japan
| | - Isamu Makino
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Kanazawa, Japan
| | - Hidehiro Tajima
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Kanazawa, Japan
| | - Hiroyuki Takamura
- Department of General and Digestive Surgery, Kanazawa Medical University, Kanazawa, Japan
| | - Tetsuo Ohta
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Kanazawa, Japan
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Soyama A, Kugiyama T, Hara T, Hidaka M, Hamada T, Okada S, Adachi T, Ono S, Takatsuki M, Eguchi S. Efficacy of an artificial pancreas device for achieving tight perioperative glycemic control in living donor liver transplantation. Artif Organs 2018; 43:270-277. [DOI: 10.1111/aor.13373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 09/13/2018] [Accepted: 10/08/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Akihiko Soyama
- Department of Surgery Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Tota Kugiyama
- Department of Surgery Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Takanobu Hara
- Department of Surgery Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Masaaki Hidaka
- Department of Surgery Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Takashi Hamada
- Department of Surgery Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Satomi Okada
- Department of Surgery Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Tomohiko Adachi
- Department of Surgery Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Shinichiro Ono
- Department of Surgery Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Mitsuhisa Takatsuki
- Department of Surgery Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Susumu Eguchi
- Department of Surgery Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
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Shi Z, Tang S, Chen Y, Lee DTF, Chair SY, Jiang B, Zhu X, Pan X, Yang J, Qin Y. Application of a glycaemic control optimization programme in patients with stress hyperglycaemia. Nurs Crit Care 2014; 21:304-10. [PMID: 25348047 DOI: 10.1111/nicc.12121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 06/25/2014] [Accepted: 07/01/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Stress-induced hyperglycaemia (SHG) can be observed in as high as 75% of critically ill patients, which can induce severe complications or adverse events. However, conventional intensive insulin therapy (CIIT) tends to induce hypoglycaemia and glucose variability. AIMS This study investigated the clinical effects of a blood glycaemic control optimization programme (BGCOP) in patients with stress hyperglycaemia post hepatobiliary or pancreatic surgery. DESIGN This study is a randomized, controlled, prospective clinical observation. METHODS Eighty-six patients with postoperative SHG were randomly divided into a control and experimental groups. Participants in the control group underwent CIIT, while participants in the experimental group underwent blood glycaemic control optimization programme (BGCOP). A range of 7·8-10·0 mmol/L was designated as the target range for effective control of blood sugar. The validity index, adverse events and complications were compared between two groups. RESULTS Compared to participants treated with CIIT, participants treated with BGCOP reached the target range of blood sugar levels more quickly (p = 0·000). The high glycaemic index (p = 0·000), incidence of hypoglycaemia (p = 0·011), and other adverse events as well as the incidence of abdominal infection (p = 0·026), incision infection (p = 0·044), and lung infection (p = 0·047) were significantly lower in participants who underwent the BGCOP than in patients treated with CIIT. CONCLUSION BGCOP can more effectively control blood sugar levels compared with CIIT in patients with SHG after hepatobiliary or pancreatic surgery. RELEVANCE TO CLINICAL PRACTICE This study provides a direction for blood glycaemic control in patients with stress hyperglycaemia post hepatobiliary or pancreatic surgery.
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Affiliation(s)
- Zeya Shi
- Surgical Intensive Care Unit, People's Hospital of Hunan Province, Changsha, Hunan, China.,Central South University School of Nursing, Changsha, Hunan, China
| | - Siyuan Tang
- Department of Cummunity Nursing, Central South University School of Nursing, Changsha, Hunan, China
| | - Yuxiang Chen
- Department of Pharmacy, Biomedical Engineering Institute, Central South University, Changsha, Hunan, China
| | - Diana T-F Lee
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Sek Y Chair
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Bo Jiang
- Hepatobiliary Surgery, People's Hospital of Hunan Province, Changsha, Hunan, China
| | - Xu Zhu
- Surgical Intensive Care Unit, People's Hospital of Hunan Province, Changsha, Hunan, China
| | - Xiaoji Pan
- Surgical Intensive Care Unit, People's Hospital of Hunan Province, Changsha, Hunan, China
| | - Jinxu Yang
- Department of Nursing, College of Medicine, Luohe, China
| | - Yuelan Qin
- Department of Nursing, People's Hospital of Hunan Province, Changsha, Hunan, China
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Tsukamoto Y, Kinoshita Y, Kitagawa H, Munekage M, Munekage E, Takezaki Y, Yatabe T, Yamashita K, Yamazaki R, Okabayashi T, Tarumi M, Kobayashi M, Mishina S, Hanazaki K. Evaluation of a Novel Artificial Pancreas: Closed Loop Glycemic Control System With Continuous Blood Glucose Monitoring. Artif Organs 2013; 37:E67-73. [DOI: 10.1111/aor.12068] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
| | | | | | | | - Eri Munekage
- Department of Surgery; Kochi University; Kochi; Japan
| | - Yuka Takezaki
- Department of Surgery; Kochi University; Kochi; Japan
| | - Tomoaki Yatabe
- Department of Anesthesiology and Critical Care Medicine, Kochi Medical School; Kochi University; Kochi; Japan
| | - Koichi Yamashita
- Department of Anesthesiology and Critical Care Medicine, Kochi Medical School; Kochi University; Kochi; Japan
| | - Rie Yamazaki
- Department of Anesthesiology and Critical Care Medicine, Kochi Medical School; Kochi University; Kochi; Japan
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Durczynski A, Strzelczyk J, Wojciechowska-Durczynska K, Borkowska A, Hogendorf P, Szymanski D, Chalubinska J, Czupryniak L. Major liver resection results in early exacerbation of insulin resistance, and may be a risk factor of developing overt diabetes in the future. Surg Today 2012; 43:534-8. [PMID: 22829443 PMCID: PMC3627012 DOI: 10.1007/s00595-012-0268-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 02/23/2012] [Indexed: 01/04/2023]
Abstract
Purpose This single center prospective cohort study evaluated the influence of hemihepatectomy on glucose homeostasis. Methods The study included 30 patients undergoing hemihepatectomy. All patients underwent an oral 75 g glucose tolerance test before (baseline), 1 week and 1 month after the surgery. Plasma glucose, insulin and glucagon were measured in the OGTT samples, and the HOMA index was calculated. The fasting levels of interleukin 6 and 1β, tumor necrosis factor and adiponectin were assessed. Results The fasting plasma and 120-min post-challenge mean glucose level increased during the study from 89.6 to 103.5 mg/dl (by 15.5 %) and from 136.4 to 162.2 (by 18.9 %; p = 0.51), respectively, accompanied by an increase in fasting glucagon (from 3.2 to 5.9 ng/mL; p = 0.043) and insulin (from 14.6 to 19.3 IU/mL) and by a decrease in plasma insulin at 60 min of OGTT (p = 0.34). An increase of IL-6 (p = 0.015) and TNF (from 49.7 to 53 pg/mL), and decrease of plasma APO (7658 to 5152 ng/mL) and exacerbation of insulin resistance (p = 0.007) were noted. Conclusion Hemihepatectomy resulted in moderate disturbances in glucose homeostasis, in a majority of patients that was likely to be of minor clinical relevance. However, the patients might be at higher risk of developing overt diabetes following long-term survival.
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Affiliation(s)
- Adam Durczynski
- Department of General and Transplant Surgery, Barlicki University Hospital, Medical University of Lodz, Kopcinskiego Street 22, 90-153 Lodz, Poland.
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Abstract
Hyperglycemia is frequently encountered in the inpatient setting and is distinctly associated with poor clinical outcomes. Recent literature suggests an association between stringent glycemic control and increased mortality, thus keeping optimal glycemic targets a relevant subject of debate. In the surgical population, hyperglycemia with or without diabetes mellitus may be unrecognized. Factors contributing to hyperglycemia in the hospital include critical illness, use of certain drugs, use of enteral or parenteral nutrition, and variability in oral or nutritional intake as can occur when patients are prepared for procedures or surgery. A sensible approach to managing hyperglycemia in this population includes preoperative recognition of diabetes mellitus and risks for inpatient hyperglycemia. Judicious control of glycemia during the pre-, intra-, and postoperative time periods with avoidance of hypoglycemia mandates the need for a strategy for patient management that extend to time of discharge. We review the consequences of uncontrolled perioperative hyperglycemia, discuss current clinical guidelines and recent controversies, and provide practical tools for glycemic control in the surgical population.
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Affiliation(s)
- Ariana Pichardo-Lowden
- Penn State College of Medicine, Penn State Hershey Diabetes and Obesity Institute, Division of Endocrinology, Diabetes and Metabolism, Hershey, PA, USA.
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Okabayashi T, Ichikawa K, Namikawa T, Sugimoto T, Kobayashi M, Hanazaki K. Effect of Perioperative Intensive Insulin Therapy for Liver Dysfunction After Hepatic Resection. World J Surg 2011; 35:2773-8. [PMID: 21976008 DOI: 10.1007/s00268-011-1299-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Takehiro Okabayashi
- Department of Surgery, Kochi Medical School, Kohasu-Okocho, Nankoku-City Kochi, 783-8505, Japan.
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Rinehart J, Liu N, Alexander B, Cannesson M. Review article: closed-loop systems in anesthesia: is there a potential for closed-loop fluid management and hemodynamic optimization? Anesth Analg 2011; 114:130-43. [PMID: 21965362 DOI: 10.1213/ane.0b013e318230e9e0] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Closed-loop (automated) controllers are encountered in all aspects of modern life in applications ranging from air-conditioning to spaceflight. Although these systems are virtually ubiquitous, they are infrequently used in anesthesiology because of the complexity of physiologic systems and the difficulty in obtaining reliable and valid feedback data from the patient. Despite these challenges, closed-loop systems are being increasingly studied and improved for medical use. Two recent developments have made fluid administration a candidate for closed-loop control. First, the further description and development of dynamic predictors of fluid responsiveness provides a strong parameter for use as a control variable to guide fluid administration. Second, rapid advances in noninvasive monitoring of cardiac output and other hemodynamic variables make goal-directed therapy applicable for a wide range of patients in a variety of clinical care settings. In this article, we review the history of closed-loop controllers in clinical care, discuss the current understanding and limitations of the dynamic predictors of fluid responsiveness, and examine how these variables might be incorporated into a closed-loop fluid administration system.
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Affiliation(s)
- Joseph Rinehart
- Department of Anesthesiology & Perioperative Care, University of California, Irvine, USA
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Kawahito S, Kitahata H, Kitagawa T, Oshita S. Intensive insulin therapy during cardiovascular surgery. THE JOURNAL OF MEDICAL INVESTIGATION 2011; 57:191-204. [PMID: 20847518 DOI: 10.2152/jmi.57.191] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Recent evidence in the fields of surgery, emergency and critical care medicine indicates that strict glycemic control results in lower mortality. Hyperglycemia occurs frequently in patients with and without diabetes during cardiovascular surgery, especially during cardiopulmonary bypass. However, strict glucose control is difficult to achieve during cardiovascular procedures. To establish effective intensive insulin therapy during cardiovascular surgery, we conduct continuous blood glucose monitoring and employ automatic control by using an artificial endocrine pancreas (the STG-22, Nikkiso, Tokyo, Japan). In this review, we will outline the present status and problems of conventional glycemic control for perioperative cardiovascular surgery and introduce the new perioperative blood glucose management method that we are testing now. We will also discuss the importance of perioperative glycemic control for cardiovascular surgery as well as future prospects.
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Affiliation(s)
- Shinji Kawahito
- Department of Anesthesiology, Tokushima University Hospital, Tokushima, Japan
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Current world literature. Curr Opin Endocrinol Diabetes Obes 2010; 17:384-93. [PMID: 20588116 DOI: 10.1097/med.0b013e32833c4b2b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sato H, Lattermann R, Carvalho G, Sato T, Metrakos P, Hassanain M, Matsukawa T, Schricker T. Perioperative glucose and insulin administration while maintaining normoglycemia (GIN therapy) in patients undergoing major liver resection. Anesth Analg 2010; 110:1711-8. [PMID: 20375299 DOI: 10.1213/ane.0b013e3181d90087] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although hyperglycemia is a well-recognized risk factor in the context of cardiac surgery, the relevance of perioperative glycemic control for patients undergoing major noncardiac operations has received little attention. We designed this study to assess the hyperglycemic response to liver resection, and to test the hypothesis that perioperative glucose and insulin administration while maintaining normoglycemia (GIN therapy) provides glycemic control superior to that achieved by the conventional use of insulin. METHODS Patients were randomly assigned to GIN therapy or standard therapy (control group). In the GIN therapy group, insulin was administered at 2 mU . kg(-1) . min(-1) during surgery. At the end of surgery, the insulin infusion was decreased to 1 mU . kg(-1) . min(-1) and continued for 24 hours. Dextrose 20% was infused at a rate adjusted to maintain blood glucose within the target range of 3.5 to 6.1 mmol . L(-1) (63-110 mg . dL(-1)). Patients in the standard therapy group received a conventional insulin sliding scale during and after surgery. The mean and SD of blood glucose as well as the percentage of blood glucose values within the target range were calculated. To evaluate intrasubject variability, the coefficient of variability (CV) of blood glucose was calculated for each patient. Episodes of severe hypoglycemia, i.e., blood glucose <2.2 mmol . L(-1) (40 mg . dL(-1)), were recorded. The primary outcome was the proportion of normoglycemic measurements. RESULTS We studied 52 patients. The mean blood glucose value in patients receiving GIN therapy always remained within the target range. The blood glucose levels were lower in the GIN therapy group than in the standard therapy group (during surgery, P < 0.01; after surgery, P < 0.001). In nondiabetic patients receiving GIN therapy (n = 19), target glycemia was achieved in 90.1% of the blood glucose measurements during surgery and in 77.8% of the measurements after surgery. In diabetic patients receiving GIN therapy (n = 7), target glycemia was achieved in 81.2% of the blood glucose measurements during surgery and in 70.5% of the measurements after surgery. In nondiabetic patients receiving standard therapy (n = 19), target glycemia was achieved in 37.4% of the blood glucose measurements during surgery and in 18.3% of the measurements after surgery. In diabetic patients receiving standard therapy (n = 7), target glycemia was achieved in 4.3% of the blood glucose measurements during surgery and in 2.9% of the measurements after surgery. The SD and CV of blood glucose were smaller in the GIN therapy group than in the standard therapy group, especially in nondiabetic patients after surgery (SD, P < 0.001; CV, P = 0.027). No patients receiving GIN therapy experienced severe hypoglycemia during surgery. One patient receiving GIN therapy experienced hypoglycemia in the intensive care unit after surgery without neurological sequelae. CONCLUSIONS GIN therapy effectively provides normoglycemia in patients undergoing liver resection (clinicaltrials.gov, NCT00774098).
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Affiliation(s)
- Hiroaki Sato
- Department of Anaesthesia, Royal Victoria Hospital, 687 Pine Ave. West, Rm. C5.20, Montreal, QC, Canada H3A 1A1
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