title: 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.affiliation: Department of Surgery, Kochi Medical School, Kohasu-Okocho, Nankoku-City, Kochi 783-8505, Japan. tokabaya@kochi-u.ac.jp
authors.forename: Takehiro
authors.initials: T
authors.lastname: Okabayashi
authors.forename: Isao
authors.initials: I
authors.lastname: Nishimori
authors.forename: Koichi
authors.initials: K
authors.lastname: Yamashita
authors.forename: Takeki
authors.initials: T
authors.lastname: Sugimoto
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Namikawa
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Maeda
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Yatabe
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Hanazaki
mesh_terms: D000368:Aged; D000597:Amino Acids, Branched-Chain / Q000008:administration & dosage* / Q000009:adverse effects; D001786:Blood Glucose / Q000032:analysis; D003422:Critical Care; D004040:Dietary Carbohydrates / Q000008:administration & dosage* / Q000009:adverse effects; D019587:Dietary Supplements / Q000009:adverse effects; D005260:Female; D006498:Hepatectomy / Q000401:mortality; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use; D007333:Insulin Resistance; D008113:Liver Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019397:Pancreas, Artificial / Q000009:adverse effects; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods*; D013997:Time Factors
chemical_list: D000597:Amino Acids, Branched-Chain; D001786:Blood Glucose; D004040:Dietary Carbohydrates; D007004:Hypoglycemic Agents; D007328:Insulin