Effects Of Perioperative Probiotics Supplement On Blood Glucose In Patients With CRC Complicated With T2DM

Background Colorectal cancer is the third most common malignancy in China and is still a common malignancy of the digestive system worldwide.Since the founding of the People’s Republic of China,the lifestyle and dietary framework of the Chinese people(including high-fat diet,low physical activity,etc.)are undergoing tremendous changes.Even with the continuous improvement of diagnosis and treatment,the morbidity and mortality are still at a high level and show an increasing trend every year.Type 2 diabetes,one of the most common types of diabetes,is a type of hyperglycemia caused by impaired biological communication of insulin and damage to the producing cells.Up to today,the number of patients with diabetes is still rising,and the clinical treatment of diabetes is limited to improving glucose metabolism and controlling blood glucose level,rather than radical treatment of the cause.In recent years,it was found that the number of colorectal cancer patients with type 2 diabetes increased year by year.Type 2 diabetes patients also have dysbacteriosis,which may be one of the causes of human diabetes and the progression of diabetes.At present,colorectal cancer treatment mainly exists in the following ways,the most important is surgical treatment,in addition to chemotherapy(including neoadjuvant chemotherapy and adjuvant chemotherapy),radiotherapy,gene therapy and biological immunotargeting therapy.The study found that there was a certain degree of imbalance of flora species,quantity,proportion and site in patients with colorectal cancer before surgery,while after perioperative related treatment,surgery and trauma,the patients showed more obvious imbalance of flora after surgery.This is mainly reflected in the decrease of the number of intestinal bacteria(represented by bifidobacteria and lactobacillus)that are beneficial to human body after operation,while the number of opportunistic pathogens and harmful bacteria(represented by escherichia coli)is increased.So,type 2 diabetes mellitus and colorectal cancer patients after surgery,trauma and perioperative related to preoperative preparation and postoperative management will appear the changes of glucose metabolism and blood glucose levels in the blood,we conducted on Chinese and English corresponding database literature retrieval,found few reports on the study of this direction.Probiotics(Bifid Lriple Viable))are used to treat acute and chronic diarrhea or constipation caused by intestinal flora imbalance,and can be used in traditional colorectal cancer surgery and chemotherapy.At present,no adverse reactions and adverse consequences have been reported in clinical application,and it is widely used in the treatment of intestinal flora imbalance before and after surgery.Objective To discuss the effect of probiotics on postoperative blood glucose metabolism in patients with T2 DM complicated with colorectal cancer during the perioperative period,and to elaborate the possible correlation mechanism,thus providing a new idea for the perioperative management of T2 DM colorectal cancer and a new theoretical research basis for the prevention and treatment of type 2 diabetes.Methods In this prospective study,Sixty patients with colorectal cancer and T2DM(type 2diabetes)undergoing elective laparoscopic radical surgery were selected from the colorectal surgery department of Qingdao municipal hospital from September 2017 to August 2019.Randomly divided into Ⅰ group(probiotics),Ⅱ group(control group),an average of 30 cases in each group.Ⅱwas carried on the traditional preoperative preparation and antibiotic used,Ⅰwas given of bifidobacterium(Bifid Lriple Viable)on the basis of Ⅱfrom three day before surgery,24 hours after the surgery continue to take the Bifid Lriple Viable to 1st month after operation.Patients in both groups were given insulin to control blood glucose after operation,and the dosage of insulin was adjusted according to fasting and blood glucose level after three meals.Intestinal flora of the two groups were measured on admission,the 8th day after surgery and the 1st month after surgery,and insulin dosage of the patients was recorded in the 1st month after surgery.Results Postoperative probiotics amounts was obviously increased compared with the preoperative in Ⅰ(p < 0.05),e.coli amounts obviously decreased after the surgery(p<0.05);Postoperative probiotics amounts was significantly decreased compared with the preoperative in Ⅱ(p < 0.05),e.coli counts increased significantly(p <0.05).Comparing with Ⅱ group,postoperative probiotics counts in was obviously increased(P < 0.05),e.coli count decreased obviously(P < 0.05).Postoperative Ⅰgroup of IL-6 and TNF-? was lower than that in groupⅡInflammatory cytokines(P <0.05).Ⅰ and Ⅱ group blood sugar control level(fasting and postprandial blood glucose level)statistics has no obvious difference in One month after surgery(P >0.05),Ⅰ insulin dosage is reduced compared with Ⅱ group(P=0.036,P<0.05).Conclusions Patients with T2 DM complicated with colorectal cancer had intestinal flora imbalance after perioperative treatment,surgery and trauma.Probiotics used during perioperative period could regulate glucose metabolism,and the possible mechanism was to regulate intestinal flora imbalance in patients and improve inflammation.