Stefan Ljunggren1, Thomas Nyström, Robert G Hahn. 1. From the Research Unit, Södertälje Hospital, Södertälje (SL, RGH), Section of Internal Medicine, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm (SL, TN) and Department of Anesthesia, Linköping University, Linköping (RGH), Sweden.
Abstract
BACKGROUND: Insulin resistance develops in the perioperative setting and has an adverse influence on postoperative recovery and well-being. OBJECTIVES: To evaluate the effectiveness of commonly used methods for quantifying surgery-induced insulin resistance. DESIGN: Prospective observational study. SETTING: Surgery department and orthopaedic ward at two regional hospitals. PATIENTS: Twenty-two patients (mean age 68 years) scheduled for elective hip replacement. INTERVENTIONS: A short seven-sample intravenous glucose tolerance test (IVGTT) followed by a euglycaemic hyperinsulinaemic glucose clamp 1 day before and 2 days after the surgery. MAIN OUTCOME MEASURES: Insulin resistance shown by dynamic tests (the IVGTT and the glucose clamp) were compared to static tests [the quantitative insulin sensitivity check index (QUICKI) and the homeostatic model assessment-insulin resistance (HOMA-IR)], which use only the plasma glucose and insulin concentrations at baseline. RESULTS: The linear correlation coefficients for the relationship between insulin resistance as obtained with the glucose clamp and the other methods before or after surgery were 0.76 (IVGTT), 0.58 (QUICKI) and -0.65 (HOMA). The prediction errors (precision) averaged 18, 29 and 31%, respectively. Surgery-induced insulin resistance amounted to 45% (glucose clamp), 26% (IVGTT), 4% (QUICKI) and 3% (HOMA). CONCLUSION: Despite reasonably good linear correlations, the static tests grossly underestimated the degree of insulin resistance that developed in response to surgery.
BACKGROUND:Insulin resistance develops in the perioperative setting and has an adverse influence on postoperative recovery and well-being. OBJECTIVES: To evaluate the effectiveness of commonly used methods for quantifying surgery-induced insulin resistance. DESIGN: Prospective observational study. SETTING: Surgery department and orthopaedic ward at two regional hospitals. PATIENTS: Twenty-two patients (mean age 68 years) scheduled for elective hip replacement. INTERVENTIONS: A short seven-sample intravenous glucose tolerance test (IVGTT) followed by a euglycaemic hyperinsulinaemic glucose clamp 1 day before and 2 days after the surgery. MAIN OUTCOME MEASURES: Insulin resistance shown by dynamic tests (the IVGTT and the glucose clamp) were compared to static tests [the quantitative insulin sensitivity check index (QUICKI) and the homeostatic model assessment-insulin resistance (HOMA-IR)], which use only the plasma glucose and insulin concentrations at baseline. RESULTS: The linear correlation coefficients for the relationship between insulin resistance as obtained with the glucose clamp and the other methods before or after surgery were 0.76 (IVGTT), 0.58 (QUICKI) and -0.65 (HOMA). The prediction errors (precision) averaged 18, 29 and 31%, respectively. Surgery-induced insulin resistance amounted to 45% (glucose clamp), 26% (IVGTT), 4% (QUICKI) and 3% (HOMA). CONCLUSION: Despite reasonably good linear correlations, the static tests grossly underestimated the degree of insulin resistance that developed in response to surgery.