Intensive Versus Conventional Insulin Therapy in Nondiabetic Patients Receiving Parenteral Nutrition After D2 Gastrectomy for Gastric Cancer: A Randomized Controlled Trial

Cao, Shougen; Zhou, Yanbing; Chen, Dong; Niu, Zhaojian; Wang, Dongsheng; Lv, Liang; Yu, Li

doi:10.1007/s11605-011-1654-z

Cited by 20 publications

(18 citation statements)

References 37 publications

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“…Five studies 31,35,38,39,41 were in patients with diabetes, eight 28 -30,33,34,36,37,40 included both patients with and those without diabetes, and two studies 32,42 considered patients without diabetes. Nine studies 28,29,33 -36,38,39,42 were performed in patients undergoing cardiac surgery, four 31,32,40,41 involved patients having abdominal surgery, one study 37 concerned critically ill surgical patients, and one study 30 involved patients undergoing emergency cerebral aneurysm clipping. Most of the studies were performed in an ICU setting.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Meta-analysis of lower perioperative blood glucose target levels for reduction of surgical-site infection

Vries

Gans

Solomkin

et al. 2017

Journal of British Surgery

117

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Background: There is a clear association between hyperglycaemia and surgical-site infection (SSI). Intensive glucose control may involve a risk of hypoglycaemia, which in turn results in potentially severe complications. A systematic review was undertaken of studies comparing intensive versus conventional glucose control protocols in relation to reduction of SSI and other outcomes, including hypoglycaemia, mortality and stroke.Methods: PubMed, Embase, CENTRAL, CINAHL and WHO databases from 1 January 1990 to 1 August 2015 were searched. Inclusion criteria were RCTs comparing intensive with conventional glucose control protocols, and reporting on the incidence of SSI. Meta-analyses were performed with a random-effects model, and meta-regression was subsequently undertaken. Targeted blood glucose levels, achieved blood glucose levels, and important adverse events were summarized.Results: Fifteen RCTs were included. The summary estimate showed a significant benefit for an intensive compared with a conventional glucose control protocol in reducing SSI (odds ratio (OR) 0⋅43, 95 per cent c.i. 0⋅29 to 0⋅64; P < 0⋅001). A significantly higher risk of hypoglycaemic events was found for the intensive group compared with the conventional group (OR 5⋅55, 2⋅58 to 11⋅96), with no increased risk of death (OR 0⋅74, 0⋅45 to 1⋅23) or stroke (OR 1⋅37, 0⋅26 to 7⋅20). These results were consistent both in patients with and those without diabetes, and in studies with moderately strict and very strict glucose control. Conclusion:Stricter and lower blood glucose target levels of less than 150 mg/dl (8⋅3 mmol/l), using an intensive protocol in the perioperative period, reduce SSI with an inherent risk of hypoglycaemic events but without a significant increase in serious adverse events.

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Section: Study Characteristicsmentioning

confidence: 99%

“…Upper limit target level < 110 mg/dl Abdelmalak et al 28 Albacker et al 29 Cao et al 31 Cao et al 32 Gandhi et al 36 Okabayashi et al 40 Yuan et al 41 Zheng et al 42 Subtotal Heterogeneity: τ 2 = 0·00; χ 2 = 6·39, 7 d.f., P = 0·50; I 2 = 0% Test for overall effect: Z = 3·63, P < 0·001…”

Section: Of 196mentioning

confidence: 99%

Meta-analysis of lower perioperative blood glucose target levels for reduction of surgical-site infection

Vries

Gans

Solomkin

et al. 2017

Journal of British Surgery

117

View full text Add to dashboard Cite

show abstract

“…Cao et al, in a single-centre, prospective, randomized controlled trial, compared the effects of intensive insulin therapy with conventional insulin therapy on postoperative outcomes among nondiabetic patients receiving parenteral nutrition following D2 gastrectomy for gastric cancer [25]. The authors demonstrated that intensive insulin therapy significantly reduced the postoperative short-term morbidity but not mortality among nondiabetic patients receiving parenteral nutrition after D2 gastrectomy.…”

Section: Discussionmentioning

confidence: 99%

“…The authors demonstrated that intensive insulin therapy significantly reduced the postoperative short-term morbidity but not mortality among nondiabetic patients receiving parenteral nutrition after D2 gastrectomy. The benefits may be due to the suppression of insulin resistance and improvement of HLA-DR expression on monocytes [25]. Wang et al [26], in a prospective study on 255 consecutive patients with gastric cancer, evaluated the association of sarcopenia, characterized by decreased skeletal muscle plus low muscle strength and/or physical performance, with short-term postoperative outcomes after gastrectomy for gastric cancer.…”

Section: Discussionmentioning

confidence: 99%

Postoperative hyperglycemia in nondiabetic patients after gastric surgery for cancer: perioperative outcomes

et al. 2016

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Background Hyperglycemia (HG) is widely known to be associated with increased postoperative complications after colorectal surgery. Very few data on the effects of HG on patients after gastric surgery for cancer are reported in literature. The aim of this study was to evaluate the effects of postoperative HG in non-diabetic patients undergoing gastrectomy for cancer. Methods One hundred and ninety-three consecutive gastrectomies for cancer performed between January 2010 and December 2015 were considered. Diabetic patients, and those undergoing pancreatic resections were excluded. Postoperative blood glucose levels were monitored in the first 72 h after surgery. Postoperative complications, mortality, and postoperative course were analyzed in patients who experienced postoperative HG (blood glucose level; BGL [ 125 mg/dl) compared with euglycemic patients (BGL B 125 mg/dl). Differences between mild HG (BGL between 125 and 200 mg/dl) and severe HG (BGL C 200 mg/dl) were also analyzed. Results Ninety-six patients (55.5 %) experienced postoperative HG. In 11 patients (6.4 %), a severe postoperative HG was found. Postoperative BGL [ 200 mg/dl was related to worse outcomes than those experienced by euglycemic patients (and even than patients who experienced mild postoperative HG). The postoperative complications rate was 24.8 % (43 patients out of 173), but significantly higher in patients with postoperative severe HG compared to mild HG and normoglycemic patients (63.6, 30.6, and 13 %, respectively, p \ 0.001). Conclusion Poor postoperative glycemic control seems to be related to worse postoperative outcomes even in patients undergoing elective gastric surgery for cancer.

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“…The incidence of such infection after elective gastrectomy was significantly greater in patients with DM (especially long-term DM) than in non-diabetic patients. 27 Recent RCTs demonstrated that intensive glucose control significantly reduced short-term morbidity in non-diabetic 28 and diabetic 29 patients undergoing gastrectomy for gastric cancer. As the FTS pathway can reduce insulin resistance and stress, we believe that it could also benefit patients with DM if implemented carefully.…”

Section: Discussionmentioning

confidence: 99%

A meta-analysis of fast track surgery for patients with gastric cancer undergoing gastrectomy

Chen¹,

Zou²,

Chen³

et al. 2015

ann r coll surg engl

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Intensive Versus Conventional Insulin Therapy in Nondiabetic Patients Receiving Parenteral Nutrition After D2 Gastrectomy for Gastric Cancer: A Randomized Controlled Trial

Cited by 20 publications

References 37 publications

Meta-analysis of lower perioperative blood glucose target levels for reduction of surgical-site infection

Meta-analysis of lower perioperative blood glucose target levels for reduction of surgical-site infection

Postoperative hyperglycemia in nondiabetic patients after gastric surgery for cancer: perioperative outcomes

A meta-analysis of fast track surgery for patients with gastric cancer undergoing gastrectomy

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