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Preoperative Carbohydrate Drink Intake Increases Glycemic Variability in Patients with Type 2 Diabetes Mellitus in Total Joint Arthroplasty: A Prospective Randomized Trial

 Bora Lee  ;  So Yeon Kim  ;  Byung Woo Cho  ;  Sungmin Suh  ;  Kwan Kyu Park  ;  Yong Seon Choi 
 WORLD JOURNAL OF SURGERY, Vol.46(4) : 791-799, 2022-04 
Journal Title
Issue Date
Administration, Oral ; Arthroplasty, Replacement, Hip* ; Arthroplasty, Replacement, Knee* ; Blood Glucose / metabolism ; Diabetes Mellitus, Type 2* / complications ; Diabetes Mellitus, Type 2* / surgery ; Dietary Carbohydrates ; Fasting ; Humans ; Insulin Resistance* / physiology ; Preoperative Care ; Prospective Studies
Background: Preoperative carbohydrate treatment attenuates insulin resistance and improves metabolism to an anabolic state. Despite these benefits, impaired glycemic control and aspiration risk related to gastroparesis represent concerns for patients with diabetes undergoing surgery. This randomized controlled trial investigated the effects of oral carbohydrate therapy on perioperative glucose variability, metabolic responses, and gastric volume in diabetic patients undergoing elective total hip or knee arthroplasty.

Methods: Fifty diabetic patients scheduled to undergo elective total knee or hip arthroplasty during August 2019-October 2020 were randomly assigned to a control or carbohydrate therapy (CHO) group. CHO group of patients received a 400-mL carbohydrate drink 2-3 h before anesthesia; control group of patients underwent overnight fasting from midnight, one night before surgery. Blood glucose levels were measured before intake of the carbohydrate drink, before spinal anesthesia, preoperatively, immediately postoperatively, and 1 h postoperatively. Insulin level and gastric volume were measured before spinal anesthesia.

Results: The glucose variability of patients in the CHO group was significantly higher than that of those in the control group (16.5 vs. 10.1%, P = 0.008). Similarly, insulin resistance was higher in the CHO group than in the control group (8.5 vs. 2.7, P < 0.001). The gastric volume did not differ significantly between the groups (61.3 vs. 15.2 ml, P = 0.082).

Conclusions: Preoperative oral carbohydrate therapy increases glucose variability and insulin resistance in diabetic patients. Therefore, carbohydrate beverages should be cautiously administered to diabetic patients, considering metabolic and safety aspects. Trial registration number ClinicalTrials.gov (No. NCT04013594).
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, So Yeon(김소연) ORCID logo https://orcid.org/0000-0001-5352-157X
Park, Kwan Kyu(박관규) ORCID logo https://orcid.org/0000-0003-0514-3257
Suh, Sungmin(서성민)
Lee, Bo Ra(이보라) ORCID logo https://orcid.org/0000-0002-7699-967X
Cho, Byung Woo(조병우) ORCID logo https://orcid.org/0000-0002-7472-4103
Choi, Yong Seon(최용선) ORCID logo https://orcid.org/0000-0002-5348-864X
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