The Effect of an Enhanced Recovery Protocol on Colorectal Surgery Patients With Diabetes

Cua, Santino; Humeidan, Michelle; Beal, Eliza W.; Brethauer, Stacy A.; Pervo, Valerie; Papio, Joe; Husain, Syed; Moffatt-Bruce, Susan D.

doi:10.1016/j.jss.2020.07.041

Cited by 13 publications

(17 citation statements)

References 17 publications

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“…During and following surgery, blood glucose was not significantly different between patients with T2DM who consume carbohydrate load and those who do not [38,40e42] The final and perhaps most important concern in the debate on carbohydrate loading in patients with DM is whether it will cause harm to patients or result in less favorable surgical outcomes (i.e., complications, pneumonia, wound infections, length of stay, and adverse events). In general, complications including aspiration and adverse events were not reported to be more common in patients with DM or insulin resistance who received preoperative carbohydrates when compared to respective controls [31,40,41]. In the previously described study by Laffin et al, it was also reported that no operations were cancelled due to hyperglycemia [38].…”

Section: Postoperative Complicationsmentioning

confidence: 92%

“…No patient in the group receiving carbohydrate experienced aspiration or pulmonary complication. Cua et al, 2021 [40] Perioperative glucose levels-> Preoperative mean peak glucose was significantly higher in the group receiving carbohydrate load (192 vs. 140 mg/dL, P < 0.000). No significant difference in mean peak glucose intraoperatively, postoperatively, on postop day 1 or days 4 e7.…”

Section: Postoperative Complicationsmentioning

confidence: 95%

“…Recently, the effect of an enhanced recovery protocol that included preoperative carbohydrate loading was examined in a retrospective study in patients with T2DM undergoing colorectal surgery [40]. Patients with T2DM that received carbohydrate loading as part of an enhanced recovery protocol (n ¼ 58) were compared to patients with T2DM that received care prior to implementation of the enhanced recovery protocol (control group; n ¼ 41).…”

Section: Postoperative Complicationsmentioning

confidence: 99%

“…In summary, preoperative blood glucose was reported to be 12.5e52.4 mg/dL higher in patients with T2DM who consume carbohydrate load than those who do not [40,41]. Data from nonsurgical patients with T2DM suggests that blood glucose returns to baseline at approximately 3 h after consumption [30,32].…”

Section: Postoperative Complicationsmentioning

confidence: 99%

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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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Section: Postoperative Complicationsmentioning

confidence: 92%

Section: Postoperative Complicationsmentioning

confidence: 95%

Section: Postoperative Complicationsmentioning

confidence: 99%

Section: Postoperative Complicationsmentioning

confidence: 99%

See 2 more Smart Citations

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

Robinson

Cassady

Hegazi

et al. 2021

Clinical Nutrition ESPEN

View full text Add to dashboard Cite

show abstract

“…Little is known about which preoperative CCDs are more frequently used in ERAS programs across United States (U.S.) hospitals. This is particularly relevant to patients with diabetes, where the use of preoperative CCDs might impact perioperative glycaemia, potentially leading to delay or case cancelation (Cua et al, 2021 ). Moreover, if surgery occurs, the dysglycemia could be detrimental (American Society of Anesthesiologists Committee, 2011 ).…”

Section: Introductionmentioning

confidence: 99%

A U.S. survey of pre-operative carbohydrate-containing beverage use in colorectal enhanced recovery after surgery (ERAS) programs

et al. 2021

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Background Carbohydrate-containing drinks (CCD) are administered preoperatively in most enhanced recovery after surgery (ERAS) programs. It is not known which types of CCDs are used, e.g., simple vs. complex carbohydrate, and if the choice of drink differs in patients with diabetes. Methods A national survey was performed to characterize the use of preoperative CCDs within the context of adult colorectal ERAS programs. The survey had questions regarding the use of preoperative CCDs, the types of beverages used, and the timing of beverage administration. The survey was administered electronically to members of the American Society for Enhanced Recovery (ASER) and manually to participants at the 2018 Perioperative Quality and Enhanced Recovery Conference in San Francisco, CA. Results Responses were received from 78 unique hospitals with a colorectal ERAS program of which 68 (87.2%) reported administering a preoperative drink. Of these, 98.5%, 80.9%, and 60.3% of hospitals administered a beverage to patients without diabetes, patients with diabetes not taking insulin, and patients with diabetes taking insulin, respectively. Surprisingly, one third of programs that administered a beverage to patients with diabetes used a simple carbohydrate drink. Conclusions This survey finds a high use of CHO-containing beverages in colorectal ERAS programs. More than half of all programs administer a CHO-containing beverage to patients with diabetes, and surprisingly, there is significant use of simple carbohydrate beverages in patients with diabetes receiving insulin.

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Pilot study on the impact of a carbohydrate loading drink on postprandial glycemic responses and gastric emptying in adults with prediabetes and type 2 diabetes mellitus

et al. 2022

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Background: Preoperative carbohydrate (CHO) loading improves patient outcomes but is not extensively studied in individuals with diabetes mellitus (DM), resulting in limited professional recommendations. This study examined postprandial glycemic responses and gastric emptying rates following consumption of a CHO drink in adults with and without DM.Methods: A single-arm, nonrandomized pilot trial was conducted in adults without DM (non-DM) (47.5 ± 2.5 years), with pre-DM (55.8 ± 3.0 years), and with type 2 DM (56.2 ± 2.5 years). Following an overnight fast, participants consumed a 50 g CHO drink followed by 1.5 g liquid paracetamol. Venous blood samples were collected at baseline (ie, t = 0 min) and 15,30, 45, 60, 90, 120, 150, 180, 210, and 240 min for plasma glucose and serum insulin and paracetamol concentrations to assess gastric emptying.Results: Participants with DM were older and had a higher body mass index than non-DM participants (31.2 ± 0.9 vs 28.2 ± 0.9). Fasting glucose and hemoglobin A1c levels differed significantly across groups (non-DM: 95.4 ± 3.6 mg/dl and 5.2% ± 0.1%; pre-DM: 111.6 ± 3.6 mg/dl and 5.8% ± 0.1%; DM: 167.4 ± 3.6 mg/dl and 7.2% ± 0.1%). Compared with the non-DM group, DM had increased glucose responses at 30-180 min. Glucose returned to baseline at 150 min in the non-DM and pre-DM groups compared with 210 min in the DM group. Paracetamol concentrations were not significantly different between the non-DM and DM groups.Conclusion: Blood glucose returned to baseline within ~2.5 h in non-DM and pre-DM groups and ~3.5 h in participants with DM following ingestion of a CHO drink. No consistent differences in gastric emptying rates were observed between participants with and without DM.

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The Effect of an Enhanced Recovery Protocol on Colorectal Surgery Patients With Diabetes

Cited by 13 publications

References 17 publications

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

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

A U.S. survey of pre-operative carbohydrate-containing beverage use in colorectal enhanced recovery after surgery (ERAS) programs

Pilot study on the impact of a carbohydrate loading drink on postprandial glycemic responses and gastric emptying in adults with prediabetes and type 2 diabetes mellitus

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