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 |
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Authors: | Takehiro Okabayashi Isao Nishimori Koichi Yamashita Takeki Sugimoto Tsutomu Namikawa Hiromichi Maeda Tomoaki Yatabe Kazuhiro Hanazaki |
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Affiliation: | 1. Department of Surgery, Kochi Medical School, Kohasu-Okocho, Nankoku-City, Kochi, 783-8505, Japan 2. Division of Endoscopic and Photodynamic Medicine, Kochi Medical School, Nankoku-City, Japan 3. Department of Anesthesiology and Critical Care Medicine, Kochi Medical School, Nankoku-City, Japan
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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. |
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