Preoperative oral supplementation with carbohydrate and branched-chain amino acid-enriched nutrient improves insulin resistance in patients undergoing a hepatectomy: a randomized clinical trial using an artificial pancreas.

Abstract

Glucose metabolism is adversely affected in patients following major surgery. Patients may develop hyperglycemia due to a combination of surgical stress and postoperative insulin resistance. A randomized trial was conducted to elucidate the effect of preoperative supplementation with carbohydrates and branched-chain amino acids on postoperative insulin resistance in patients undergoing hepatic resection. A total of 26 patients undergoing a hepatectomy for the treatment of a hepatic neoplasm were randomly assigned to receive a preoperative supplement of carbohydrate and branched-chain amino acid-enriched nutrient mixture or not. The postoperative blood glucose level and the total insulin requirement for normoglycemic control during the 16 h following hepatic resection were determined using the artificial pancreas STG-22. Postoperative insulin requirements for normoglycemic control in the group with preoperative nutritional support was significantly lower than that in the control group (P = 0.039). There was no incidence of hypoglycemia (<40 mg/dL) observed in patients, including those with diabetes mellitus, when the STG-22 was used to control blood glucose levels. STG-22 is a safe and reliable tool to control postoperative glucose metabolism and evaluate insulin resistance. The preoperative oral administration of carbohydrate and branched-chain amino acid-enriched nutrient is of clinical benefit and reduces postoperative insulin resistance in patients undergoing hepatic resection.

• Authors: Takehiro Okabayashi, Isao Nishimori, Koichi Yamashita, Takeki Sugimoto, Tsutomu Namikawa, Hiromichi Maeda, Tomoaki Yatabe, Kazuhiro Hanazaki
• Journal: Amino acids (Amino Acids) Vol. 38 Issue 3 Pg. 901-7 (Mar 2010) ISSN: 1438-2199 [Electronic] Austria
• PMID: 19399583 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Amino Acids, Branched-Chain
• Blood Glucose
• Dietary Carbohydrates
• Hypoglycemic Agents
• Insulin

Topics

• Aged
• Amino Acids, Branched-Chain (administration & dosage, adverse effects)
• Blood Glucose (analysis)
• Critical Care
• Dietary Carbohydrates (administration & dosage, adverse effects)
• Dietary Supplements (adverse effects)
• Female
• Hepatectomy (mortality)
• Humans
• Hyperglycemia (prevention & control)
• Hypoglycemic Agents (administration & dosage, therapeutic use)
• Insulin (administration & dosage, therapeutic use)
• Insulin Resistance
• Liver Neoplasms (surgery)
• Male
• Middle Aged
• Pancreas, Artificial (adverse effects)
• Postoperative Complications (prevention & control)
• Preoperative Care (methods)
• Time Factors