Continuous postoperative blood glucose monitoring and control by artificial pancreas in patients having pancreatic resection: a prospective randomized clinical trial.
OBJECTIVE
To evaluate a closed-loop system providing continuous monitoring and strict control of perioperative blood glucose following pancreatic resection.


METHODS
Prospective, randomized clinical trial.


METHODS
Thirty patients who had pancreatic resection for pancreatic neoplasm.


METHODS
Patients were prospectively randomized. Perioperative blood glucose levels were continuously monitored using an artificial endocrine pancreas (STG-22). Glucose levels were controlled using either the sliding scale method (sliding scale group, n = 13) or the artificial pancreas (artificial pancreas group, n = 17).


METHODS
Incidence of severe hypoglycemia (<40 mg/dL) during the intensive care period following pancreatic resection in patients monitored with the artificial pancreas. The secondary outcome measure was the total amount of insulin required for glycemic control in the first 18 hours after pancreatic resection in each patient group.


RESULTS
In the sliding scale group, postoperative blood glucose levels rose initially before reaching a plateau of approximately 200 mg/dL between 4 and 6 hours after pancreatectomy. The levels remained high for 18 hours postoperatively. In the artificial pancreas group, blood glucose levels reduced steadily, reaching the target zone (80-110 mg/dL) by 6 hours after surgery. The total insulin dose administered per patient during the first postoperative 18 hours was significantly higher in the artificial pancreas group (mean [SD], 107 [109] IU) than the sliding scale group (8 [6] IU; P < .01). Neither group showed hypoglycemia.


CONCLUSIONS
Perioperative use of an artificial endocrine pancreas to control pancreatogenic diabetes after pancreatic resection is an easy and effective way to maintain near-normal blood glucose levels. The artificial pancreas shows promise for use as insulin treatment for patients with pancreatogenic diabetes after pancreatic resection.
Department of Surgery, Kochi Medical School, Kohasu-Okocho, Nankoku-City, Kochi 783-8505, Japan. tokabaya@kochi-u.ac.jp
Takehiro
T
Okabayashi
Isao
I
Nishimori
Koichi
K
Yamashita
Takeki
T
Sugimoto
Hiromichi
H
Maeda
Tomoaki
T
Yatabe
Takuhiro
T
Kohsaki
Michiya
M
Kobayashi
Kazuhiro
K
Hanazaki
D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D002277:Carcinoma / Q000097:blood / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation; D019397:Pancreas, Artificial; D010180:Pancreatectomy / Q000009:adverse effects*; D010190:Pancreatic Neoplasms / Q000097:blood / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin