Comment on “Enhanced Recovery in Patients With Diabetes: Is It Time for a Moratorium on Use of Preoperative Carbohydrate Beverages?” I Agree With Your Perspective

Morin, Nathaniel P.

doi:10.1097/sla.0000000000003303

Cited by 2 publications

(1 citation statement)

References 10 publications

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“…However, is still controversial whether POCs should be applied to patients with type 2 diabetes mellitus (T2DM) ( 1 ). Some clinicians have claimed that POC neither exerts significant benefits for perioperative glycaemic control nor accelerates ERAS ( 2 – 4 ), and it is recommended to suspend the use of POC for T2DM patients ( 5 , 6 ). However, supporters of POC believe that intake of carbohydrates 2–3 h before surgery can reduce thirst, hunger, anxiety, insulin resistance, nausea, vomiting and other complications ( 7 – 10 ).…”

Section: Introductionmentioning

confidence: 99%

Preoperative Oral Carbohydrate Levels in Patients with Type 2 Diabetes Mellitus: The Clinical Guiding Significance of Free Fatty Acids

et al. 2022

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BackgroundIt is still controversial whether preoperative oral carbohydrate (POC) should be applied to patients with type 2 diabetes mellitus (T2DM) in the enhanced recovery after surgery (ERAS) protocol. There is no relevant consensus or indicators to provide guidance as to whether T2DM patients should take POC.MethodsIn total, 164 T2DM patients who underwent laparoscopic hepatectomy were analyzed. According to the level of blood free fatty acids (FFAs) and whether the patients received POC, the patients were divided into 6 groups: the low FFA carbohydrate group (LFFAC group), low FFA fasting water group (LFFAF group), medium FFA carbohydrate group (MFFAC group), medium FFA fasting water group (MFFAF group), high FFA carbohydrate group (HFFAC group) and high FFA fasting water group (HFFAF group).ResultsPatients with low FFA levels showed better perioperative blood glucose control and a lower incidence of postoperative complications than those in the medium and high FFA groups, especially when patients received POC. Further analyses revealed that the postoperative plasma concentrations of IL-6 and TNF-α were significantly decreased in the POC group compared with the fasting water group, except for patients with high FFA levels. Receiver operating characteristic (ROC) curve analysis revealed that when the FFA concentration was higher than 0.745 mmol/L, the risk of poor blood glucose control during the perioperative period was increased.ConclusionsFFAs have clinical guiding significance for the application of POC in patients with T2DM under ERAS administration. T2DM patients with low FFAs are more suitable for receiving POC.

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Section: Introductionmentioning

confidence: 99%

Preoperative Oral Carbohydrate Levels in Patients with Type 2 Diabetes Mellitus: The Clinical Guiding Significance of Free Fatty Acids

et al. 2022

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Preoperative carbohydrate loading in surgical patients with type 2 diabetes: Are concerns supported by data?

Robinson

Cassady

Hegazi

et al. 2021

Clinical Nutrition ESPEN

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Currently, there is a lack of consensus on the provision of preoperative carbohydrate loading in patients with type 2 diabetes mellitus (T2DM) due to theoretical concerns including the possibility of delayed gastric emptying, perioperative hyperglycemia, and poor surgical outcomes. This narrative review summarizes the accumulating evidence on preoperative carbohydrate loading in this population and whether these concerns are supported by preliminary evidence. In general, the available research suggests that carbohydrate loading may be implemented in those with T2DM without increased risk for intra-and postoperative hyperglycemia or surgical complications. However, there is strong justification for future research to definitively study this highly debated and timely topic. Ultimately, the inclusion of preoperative carbohydrate loading for surgical patients with DM should be guided by the surgical team's clinical judgment and individualized based on patient needs and characteristics.

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Comment on “Enhanced Recovery in Patients With Diabetes: Is It Time for a Moratorium on Use of Preoperative Carbohydrate Beverages?” I Agree With Your Perspective

Cited by 2 publications

References 10 publications

Preoperative Oral Carbohydrate Levels in Patients with Type 2 Diabetes Mellitus: The Clinical Guiding Significance of Free Fatty Acids

Preoperative Oral Carbohydrate Levels in Patients with Type 2 Diabetes Mellitus: The Clinical Guiding Significance of Free Fatty Acids

Preoperative carbohydrate loading in surgical patients with type 2 diabetes: Are concerns supported by data?

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