The effect of perioperative glucose control on postoperative insulin resistance

Blixt, Christina; Ahlstedt, Christian; Ljungqvist, Olle; Isaksson, Bengt; Kalman, Sigridur; Rooyackers, Olav

doi:10.1016/j.clnu.2012.02.011

Cited by 29 publications

(19 citation statements)

References 247 publications

(397 reference statements)

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“…54 Normoglycemia and protein balance can be maintained to some extent by large doses of insulin, indicating that insulin sensitivity is reduced (defined as an abnormal response to a normal concentration of insulin) throughout the period of intraoperative surgical stress, probably as a result of the raised inflammatory response that affects insulin target cells (myocytes, adipocytes, hepatocytes). 54 It remains to be seen whether other pharmacological or nutritional modalities could be introduced to minimize insulin resistance.…”

Section: Perioperative Feedingmentioning

confidence: 99%

“…31,34,54 The addition of nutritional supplementation while receiving postoperative neuraxial analgesia promotes protein synthesis and improves postoperative protein balance. 55 Maintaining a patient's normothermic state during surgery has been shown to attenuate the perioperative release of catecholamines 56 and decrease loss of body nitrogen.…”

Section: Maintaining Physiologic Homeostasismentioning

confidence: 99%

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Physiologic considerations of Enhanced Recovery After Surgery (ERAS) programs: implications of the stress response

Carli

2014

Can J Anesth/J Can Anesth

162

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Purpose Enhanced Recovery After Surgery (ERAS) programs have increasingly attracted the attention of clinicians who are intent on minimizing postoperative morbidity, decreasing variability in surgical care, and containing hospital costs. The purpose of this review is to discuss the relevant pathophysiology of the surgical stress response and its associated mechanisms that regulate important metabolic changes.

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Section: Perioperative Feedingmentioning

confidence: 99%

Section: Maintaining Physiologic Homeostasismentioning

confidence: 99%

Physiologic considerations of Enhanced Recovery After Surgery (ERAS) programs: implications of the stress response

Carli

2014

Can J Anesth/J Can Anesth

162

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“…In colorectal and pancreatic surgery, early postoperative hyperglycemia was associated with adverse outcomes [19,94,95]. Postoperative insulin sensitivity is significantly reduced in patients not treated with insulin during surgery [96]. In addition, there is a rapid change in glucose concentration during hepatectomy with Pringle maneuver, reflecting glycogen breakdown within hepatocytes because of hypoxia [97].…”

Section: Postoperative Glycaemic Controlmentioning

confidence: 99%

Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations

et al. 2016

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Background Enhanced Recovery After Surgery (ERAS) is a multimodal pathway developed to overcome the deleterious effect of perioperative stress after major surgery. In colorectal surgery, ERAS pathways reduced perioperative morbidity, hospital stay and costs. Similar concept should be applied for liver surgery. This study presents the specific ERAS Society recommendations for liver surgery based on the best available evidence and on expert consensus. Methods A systematic review was performed on ERAS for liver surgery by searching EMBASE and Medline. Five independent reviewers selected relevant articles. Quality of randomized trials was assessed according to the Jadad score and CONSORT statement. The level of evidence for each item was determined using the GRADE system. The Delphi method was used to validate the final recommendations. Results A total of 157 full texts were screened. Thirty-seven articles were included in the systematic review, and 16 of the 23 standard ERAS items were studied specifically for liver surgery. Consensus was reached among experts after 3 rounds. Prophylactic nasogastric intubation and prophylactic abdominal drainage should be omitted. The use of postoperative oral laxatives and minimally invasive surgery results in a quicker bowel recovery and shorter hospital stay. Goal-directed fluid therapy with maintenance of a low intraoperative central venous pressure induces faster recovery. Early oral intake and mobilization are recommended. There is no evidence to prefer epidural to other types of analgesia. Conclusions The current ERAS recommendations were elaborated based on the best available evidence and endorsed by the Delphi method. Nevertheless, prospective studies need to confirm the clinical use of the suggested protocol.

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“…Stress-induced hyperglycemia is common in critically ill patients due to acute metabolic alterations leading to increased hepatic glucose release and reduced glucose uptake in peripheral tissues [1, 2]. In patients with preserved beta-cell function, increased endogenous insulin secretion counter-balances such insulin resistance.…”

Section: Introductionmentioning

confidence: 99%

The effect of insulin administration on c-peptide in critically ill patients with type 2 diabetes

Crisman

Lucchetta

Luethi

et al. 2017

Ann. Intensive Care

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BackgroundIn critically ill patients with permissive hyperglycemia, it is uncertain whether exogenous insulin administration suppresses or enhances c-peptide secretion (a marker of pancreatic beta-cell response). We aimed to explore this effect in patients with type 2 diabetes.MethodsWe prospectively enrolled a cohort of 45 critically ill patients with type 2 diabetes managed according to a liberal glucose protocol (target blood glucose 10–14 mmol/l). We recorded the administration of insulin and oral hypoglycemic agents and measured plasma c-peptide as surrogate marker of endogenous insulin secretion on the first two consecutive days in ICU.ResultsOverall, 20 (44.4%) patients required insulin to achieve target blood glucose. Insulin-treated patients had higher glycated hemoglobin A1c, more premorbid insulin-requiring type 2 diabetes, and greater blood glucose levels but lower c-peptide levels on admission. Premorbid insulin-requiring diabetes was independently associated with lower admission c-peptide, whereas greater plasma creatinine was independently associated with higher levels. Increases in c-peptide were positively correlated with an increase in blood glucose both in patients who did (r = 0.54, P = 0.01) and did not (r = 0.56, P = 0.004) receive insulin. However, insulin administration was independently associated with a greater increase in c-peptide (P = 0.04). This association was not modified by the use of oral insulin secretagogues.ConclusionsC-peptide, a marker of beta-cell response, responds to and is influenced by glycemia and renal function in critically ill patients with type 2 diabetes. In addition, in our cohort, exogenous insulin administration was associated with a greater increase in c-peptide in response to hyperglycemia. Trial Registration Australian New Zealand Clinical Trials Registry (ACTRN12615000216516).Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-017-0274-5) contains supplementary material, which is available to authorized users.

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The effect of perioperative glucose control on postoperative insulin resistance

Cited by 29 publications

References 247 publications

Physiologic considerations of Enhanced Recovery After Surgery (ERAS) programs: implications of the stress response

Physiologic considerations of Enhanced Recovery After Surgery (ERAS) programs: implications of the stress response

Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations

The effect of insulin administration on c-peptide in critically ill patients with type 2 diabetes

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