Impact of using a perioperative artificial endocrine pancreas in pancreatic resection

Yoshimoto, Toshiaki; Ikemoto, Tetsuya; Morine, Yuji; Imura, Satoru; Saito, Yu; Yamada, Shinichiro; Miyazaki, Katsuki; Takehara, Yukako

doi:10.1002/ags3.12374

Cited by 6 publications

(5 citation statements)

References 23 publications

(47 reference statements)

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“…Some recent reports 14‐17 supported our previous data that perioperative strict glycemic control using a bedside AP was useful in improving surgical outcomes after gastroenterological surgeries. Hayashi et al 14 suggested that perioperative IIT using an AP was safe, with no hypoglycemia in 50 patients undergoing pancreatoduodenectomy (PD) (n = 24), major hepatectomy (n = 22), and liver transplantations (n = 4).…”

Section: Current Bedside Ap Stg‐55 With Closed‐loop Systemsupporting

confidence: 68%

“…Hayashi et al 14 suggested that perioperative IIT using an AP was safe, with no hypoglycemia in 50 patients undergoing pancreatoduodenectomy (PD) (n = 24), major hepatectomy (n = 22), and liver transplantations (n = 4). Yoshimoto et al 15 reported that perioperative AP treatment was safe without hypoglycemia and significantly reduced serious complications (Clavien‐Dindo grade >IIIa) after pancreatectomy. Akabori et al 16 demonstrated that AP facilitated strict and safe glycemic control while reducing inflammatory mediators, including adiponectin, after PD.…”

Section: Current Bedside Ap Stg‐55 With Closed‐loop Systemmentioning

confidence: 99%

“…A good indication of perioperative glycemic control using bedside AP is shown in Table 1. Gastroenterological surgery, [14][15][16][17] cardiovascular surgery, [19][20][21][22][23] and transplantation [24][25][26] are likely to cause surgical stress-induced hyperglycemia, leading to infectious complications causing poor surgical outcomes. Moreover, other specific diseases and/or cases with diabetes, glucose intolerance, and uncontrolled glycemic administration due to conventional glycemic control methods, such as the sliding-scale method and bolus injection insulin therapy (Table 1), contribute to poor surgical outcomes.…”

Section: Perioperative Strict Glycemic Control Using Apmentioning

confidence: 99%

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Closed‐loop artificial endocrine pancreas from Japan

et al. 2021

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The development of a closed‐loop artificial pancreas (AP) in the Western countries and Japan is different. In Western countries, wearable AP with a closed‐loop glycemic control system has been developed as a treatment for patients with type 1 and type 2 diabetes. On the contrary, in Japan, bedside closed‐loop AP explored by a Japanese company (Nikkiso, Tokyo, Japan) has developed as perioperative glycemic control device in surgical patients and acute care patients with emergency. In this article, we reviewed the scientific evidence in the past and present and future prospects of perioperative glycemic control using bedside AP with a closed‐loop system in Japan. Conventional perioperative strict glycemic controls have three major problems: hyperglycemia, hypoglycemia, and variability in blood glucose concentrations. In Japan, perioperative strict glycemic control using the current bedside AP STG‐55 (Nikkiso, Tokyo, Japan) has been developed since 2010. This novel glycemic control method achieved not only stable glycemic control without hyperglycemia, hypoglycemia, and less variability of blood glucose concentrations but also reduced postoperative infectious complications in patients undergoing major surgeries. Among the rapidly increasing number of surgical or emergency patients with diabetes, frailty, and sarcopenia of intrinsic glucose intolerance, more sophisticated and smaller AP available easily in operating rooms and intensive care units will be warranted to promote improved therapeutic outcomes in such critically ill patients.

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Section: Current Bedside Ap Stg‐55 With Closed‐loop Systemsupporting

confidence: 68%

Section: Current Bedside Ap Stg‐55 With Closed‐loop Systemmentioning

confidence: 99%

Section: Perioperative Strict Glycemic Control Using Apmentioning

confidence: 99%

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Closed‐loop artificial endocrine pancreas from Japan

et al. 2021

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“…Die postoperative glykämische Kontrolle bei Herz-Thoraxchirurgie konnte in einer weiteren Arbeit mittels Bedside-AI verbessert werden, wobei die Ergebnisse unabhängig vom Diabetesstatus des eingeschlossenen Kollektivs waren [ 156 ]. Es wird darüber hinaus postuliert, dass durch den perioperativen Einsatz des oben angeführten künstlichen Pankreassystems postoperative Komplikationen reduziert werden könnten [ 157 , 158 ]. Eine andere Studie zeigte bei einem kardiochirurgischen Kollektiv, dass automatisierte intravenöse Insulinzufuhr die Patient:innen im glykämischen Zielbereich halten konnte ohne Hypoglykämien zu erhöhen [ 159 ].…”

Section: Perioperative Medikamentöse Diabetestherapieunclassified

Position statement: surgery and diabetes mellitus (Update 2023)

Kietaibl

Huber²,

Clodi

et al. 2023

Wien Klin Wochenschr

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ZusammenfassungDas vorliegende Positionspapier beschreibt die Sicht der Österreichischen Diabetes Gesellschaft hinsichtlich des perioperativen Managements von Menschen mit Diabetes mellitus auf Basis der verfügbaren wissenschaftlichen Evidenz. Dabei wird Bezug genommen auf die präoperative Begutachtung und Vorbereitung sowie auf die perioperative Stoffwechselkontrolle mittels oraler Antidiabetika und/oder injektabler Therapie (Insulin‑/GLP-1-RA-therapie).

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“…In another study, an early postoperative glucose level of higher than 140 mg/dL was significantly associated with postoperative complications in patients with and without DM [ 9 ]. The intensive SGL control group had significantly fewer bile leaks, pancreatic fistulae, and hospitalizations than the intermediate glucose control group, in an artificial endocrine pancreas study for patients who received a pancreatic resection; complications with a Clavien-Dindo classification (CDc) of higher than grade III occurred significantly less in the group whose target was 120–180 mg/dL [ 10 , 11 ]. Other studies have shown that an artificial pancreas promotes tight and safe glycemic control while reducing anti-inflammatory mediators, including adiponectin, after pancreaticoduodenectomy (PD) [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Short-Term Surgical Outcomes According to Immediately Postoperative Serum Glucose Level in Non-Diabetic Pancreatic Resection Patients

et al. 2022

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The adequate regulation of postoperative serum glucose level (SGL) is widely accepted; however, the effects for non-diabetic patients who underwent major pancreatic surgery have not yet been established. We discerned the relevance of the immediately postoperative SGL to short-term postoperative outcomes from major pancreatic surgery in non-diabetic patients. Between January 2007 and December 2016, 2259 non-diabetic patients underwent major pancreatic surgery at four tertiary medical centers in Republic of Korea. Based on a SGL of 200 mg/dL, patients were classified into two groups by averaging the results of four SGL tests taken on the first day after surgery, and their short-term postoperative outcomes were analyzed. A 1:1 propensity score matching method was conducted to establish the high SGL group (n = 568) and the normal SGL group (n = 568). The high SGL group experienced a significantly higher rate of level C complications in the Clavien-Dindo classification (CDc) than the normal SGL group (24.1% vs. 16.5%, p = 0.002). Additionally, an SGL of more than 200 mg/dL was associated with a significantly high risk of complications above level C CDc after adjusting for other risk factors (hazard ratio = 1.324, 95% confidence interval = 1.048–1.672, p = 0.019). The regulation of SGL of less than 200 mg/dL in non-diabetic patients early after major pancreatic surgery could be helpful for reducing postoperative complications.

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Impact of using a perioperative artificial endocrine pancreas in pancreatic resection

Cited by 6 publications

References 23 publications

Closed‐loop artificial endocrine pancreas from Japan

Closed‐loop artificial endocrine pancreas from Japan

Position statement: surgery and diabetes mellitus (Update 2023)

Comparison of Short-Term Surgical Outcomes According to Immediately Postoperative Serum Glucose Level in Non-Diabetic Pancreatic Resection Patients

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