Stephanie D Talutis1, Su Yeon Lee2, Daniel Cheng3, Pamela Rosenkranz4, Sara M Alexanian5, David McAneny4. 1. Department of Surgery, Boston Medical Center, Boston, MA, USA. Electronic address: Stephanie.Talutis@bmc.org. 2. Department of Surgery, Montefiore Medical Center, Bronx, NY, USA. 3. Department of Surgery, University of Nevada, Las Vegas, NV, USA. 4. Department of Surgery, Boston Medical Center, Boston, MA, USA. 5. Department of Endocrinology, Boston Medical Center, Boston, MA, USA.
Abstract
BACKGROUND: We aimed to determine the effects of preoperative carbohydrate-loading (CHO) as part of an enhanced recovery after surgery (ERAS) pathway on patients with/without type II diabetes (DMII). METHODS: Retrospective review of ERAS patients with CHO, including 80 with DMII, 275 without DMII in addition to 89 patients with DMII from the previous (non-ERAS) year. Outcomes included glucose-levels, insulin requirements, and complications. Logistic regression was used to determine the association of any complication with perioperative glucose control variables. RESULTS: Among ERAS versus non-ERAS patients with DMII, there were significant differences in median preoperative (142 mg/dL versus 129.5 mg/dL, p = 0.017) and postoperative day-1 glucose levels (152 mg/dL, versus 137.5 mg/dL, p = 0.004). There were no differences in insulin requirements, hypoglycemic episodes, or complications. Complications were not associated with Hgb-A1C%, home DMII-medications, or preoperative glucose measurement on logistic regression. CONCLUSIONS: Patients with DMII tolerated CHO without increasing insulin requirements or substantially affecting glucose levels or complications.
BACKGROUND: We aimed to determine the effects of preoperative carbohydrate-loading (CHO) as part of an enhanced recovery after surgery (ERAS) pathway on patients with/without type II diabetes (DMII). METHODS: Retrospective review of ERAS patients with CHO, including 80 with DMII, 275 without DMII in addition to 89 patients with DMII from the previous (non-ERAS) year. Outcomes included glucose-levels, insulin requirements, and complications. Logistic regression was used to determine the association of any complication with perioperative glucose control variables. RESULTS: Among ERAS versus non-ERAS patients with DMII, there were significant differences in median preoperative (142 mg/dL versus 129.5 mg/dL, p = 0.017) and postoperative day-1 glucose levels (152 mg/dL, versus 137.5 mg/dL, p = 0.004). There were no differences in insulin requirements, hypoglycemic episodes, or complications. Complications were not associated with Hgb-A1C%, home DMII-medications, or preoperative glucose measurement on logistic regression. CONCLUSIONS:Patients with DMII tolerated CHO without increasing insulin requirements or substantially affecting glucose levels or complications.