Preoperative Oral Carbohydrate Alleviates Postoperative Insulin Resistance In Patients With Type 2 Diabetes Mellitus

BackgroundSurgery leads to insulin resistance by stimulating the endocrine system and inflammatory system of human body.Actually,Insulin resistance affects the metabolism of sugar,lipids and proteins in the body,contributing to postoperative hyperglycemia.Postoperative hyperglycemia increases postoperative complication rate,infection and mortality rate.In addition,postoperative hyperglycema prolongs hospital stay and increases the hospitalization costs.Currently,oral carbohydrates for patient have been widely used before elective surgery,which can bring many clinical benefits to surgical patients.Up to now,some studies have comfirmed that in healthy patients,consuming oral carbohydrate2 hours before elective surgery can reduce preoperative anxiety,thirst,hunger,and other discomfort,while reducing the incidence of postoperative nausea and vomiting,allivating postoperative insulin resistance.Type 2 diabetes patients have their own insulin resistance,and the stress response caused by surgery and fasting enhances insulin resistance in patients with type 2 diabetes,which has an adverse effect on the prognosis of patients with type 2 diabetes undergoing elective surgery.This study was to observe whether taking oral carbohydrate before the surgery in patients with type 2 diabetes mellitus can reduce preoperative discomfort and postoperative insulin resistance,reduce the incidence of nausea and vomiting on the first day afer surgery,improve the patients’sleep quality,and reduce the patients’hospitalization time and costs.thus contributing to the recovery of patients.Seeking ways to reduce postoperative insulin resistance in patients with type 2 diabetes.MethodsThe subjects of this study were elective orthopedic surgery combined with type 2 diabetes.The enrolled patients were randomly divided into a carbohydrate group（group A）and a fasting group（group B）using a random number table.There are 30 samples in each group.Patients in group A received 400 ml of carbohydrates 3 hours before induction of anesthesia.However,patients in Group B were fasted.Subjective comfort VAS were measured 18 hours before surgery and 1 hour before surgery.Otherwise,peripheral venous blood samples（8ml）from patients in two groups were taken 4 h before surgery and at the end of surgery,to measure blood glucose and insulin.Calculating HOMA-IR,HOMA-ISI,HOMA-β.When the patients entered the room,the induction of anesthesia was started,artificial airway was established,and orthopedic surgery was performed.Main outcome measures:VAS scores at 18 hours before surgery and 1 hour before surgery,HOMA-IR,HOMA-ISI,HOMA-βat 4 hours before surgery and at the end of surgery.Secondary observations:record the vital signs（blood sugar,MAP,HR,Temp,SpO₂,BIS）,operative time,after 5 minutes of intravenous administration of midazolam,1 hour of surgery,2 hours of surgery,and end of surgery.Anesthesia time,total sleep time on the first day after surgery,and sleep quality VAS.Total dose of insulin and vasoactive drugs during anesthesia.The number of patients with nausea and vomiting on the first day after surgery,the indwelling time of the drainage tube,the first feeding time after surgery,the first exhaust time,the hospitalization time,ande the hospitalization cost.Statistical analysis was performed on the measured data.Statistical anaylsis was performed using SPSS20.0 software.General data were expressed as mean±standard deviation,normal measurement data were analyzed by independent sample t test,and non-normal measurement data were analyzed by Mann-Whitney U test,count data using X² test,P<0.05 or P<0.001 considered the difference was statistically significant.ResultsMain outcome measures:oral administration of 400 ml of carbohydrates 3 hours before surgery significantly reduced thirst and hunger in patients with type 2 diabetes 1 hour before surgery（P<0.001）.surgical stress significantly increased the blood glucose,insulin,and HOMA-IR（P<0.05）,but it decreased HOMA-ISI in type 2 diabetic patients（P<0.05）.Oral administration of 400 ml of carbohydrates 3 hours before surgery significantly reduced blood glucose,insulin,and HOMA-IR in type 2 diabetic patients（P<0.05）,and increased HOMA-ISI（P<0.05）.secondary indicators:there are no significant differences in blood sugar,MAP,HR,Temp,SpO₂,BIS,operation time,and anesthesia time between the two groups.There was no significant difference in the total amount of insulin used during surgery and the total amount of vasoactive drugs.The total sleep time,sleep quality VAS on the first day after surgery,the number of patients with nausea and vomiting on the first day after surgery,the indwelling time of the drainage tube,the first feeding time after surgery,and the first exhaust time,hospital stay and hospitalization costs.ConclusionIn patients with type 2 diabetes mellitus undergoing elective orthopedic surgery,consuming 400 ml oral carbohydrates 3 hours before surgery can significantly reduce preoperative thirst and hunger,alleviate postoperative insulin resistance,and enhance postoperative insulin sensitivity.