Department of Surgery, Boston Medical Center, Boston, MA, USA.
Department of Surgery, Montefiore Medical Center, Bronx, NY, USA.
Am J Surg. 2020 Oct;220(4):999-1003. doi: 10.1016/j.amjsurg.2020.03.032. Epub 2020 Mar 30.
We aimed to determine the effects of preoperative carbohydrate-loading (CHO) as part of an enhanced recovery after surgery (ERAS) pathway on patients with/without type II diabetes (DMII).
Retrospective review of ERAS patients with CHO, including 80 with DMII, 275 without DMII in addition to 89 patients with DMII from the previous (non-ERAS) year. Outcomes included glucose-levels, insulin requirements, and complications. Logistic regression was used to determine the association of any complication with perioperative glucose control variables.
Among ERAS versus non-ERAS patients with DMII, there were significant differences in median preoperative (142 mg/dL versus 129.5 mg/dL, p = 0.017) and postoperative day-1 glucose levels (152 mg/dL, versus 137.5 mg/dL, p = 0.004). There were no differences in insulin requirements, hypoglycemic episodes, or complications. Complications were not associated with Hgb-A1C%, home DMII-medications, or preoperative glucose measurement on logistic regression.
Patients with DMII tolerated CHO without increasing insulin requirements or substantially affecting glucose levels or complications.
我们旨在确定作为术后加速康复（ERAS）方案一部分的术前碳水化合物负荷（CHO）对合并/不合并 2 型糖尿病（DMII）的患者的影响。
对接受 CHO 的 ERAS 患者进行回顾性分析，包括 80 例合并 DMII 的患者、275 例不合并 DMII 的患者以及前一年（非 ERAS 年）的 89 例合并 DMII 的患者。结局包括血糖水平、胰岛素需求和并发症。采用逻辑回归确定与围手术期血糖控制变量相关的任何并发症的关联。
在 ERAS 组与非 ERAS 组合并 DMII 的患者中，术前（142mg/dL 比 129.5mg/dL，p=0.017）和术后第 1 天的血糖水平（152mg/dL 比 137.5mg/dL，p=0.004）存在显著差异。胰岛素需求、低血糖发作或并发症方面无差异。逻辑回归显示，并发症与 Hgb-A1C%、家用 DMII 药物或术前血糖测量均无关联。
合并 DMII 的患者耐受 CHO 治疗，不会增加胰岛素需求，也不会显著影响血糖水平或并发症。
