title: Intensive versus conventional insulin therapy in nondiabetic patients receiving parenteral nutrition after D2 gastrectomy for gastric cancer: a randomized controlled trial.
abstract: BACKGROUND
  This study was used to compare the effects of intensive insulin therapy with conventional insulin therapy on postoperative outcomes among nondiabetic patients receiving parenteral nutrition following D2 gastrectomy for gastric cancer.
  
  
  METHODS
  A total of 248 eligible patients were randomly assigned to receive intensive insulin therapy targeting a blood glucose level between 4.4 and 6.1 mmol/l [intensive group (n = 125)] or conventional insulin therapy targeting a blood glucose level less than 11.0 mmol/l [conventional group (n = 123)] during the postoperative period.
  
  
  RESULTS
  Mean blood glucose concentrations were lower in the intensive group than in the conventional group. Severe hypoglycemia defined as blood glucose ≤2.2 mmol/l occurred in eight (6.4%) patients in the intensive group vs one (0.8%) patient in the conventional group (P = 0.036). One (0.8%) patient died in the intensive group vs two (1.6%) patients in the conventional group (P = 0.620). However, intensive insulin therapy significantly reduced overall postoperative complications rate (from 25.2% to 13.6%, P = 0.024). Moreover, both insulin resistance indicated as HOMA-IR and HLA-DR expression on monocytes were improved in the intensive group.
  
  
  CONCLUSIONS
  Intensive insulin therapy significantly reduced the postoperative short-term morbidity but not mortality among nondiabetic patients receiving parenteral nutrition after D2 gastrectomy. The benefits may be due to the suppression of insulin resistance and improvement of HLA-DR expression on monocytes.
authors: Department of General Surgery, Affiliated Hospital of Medical College Qingdao University, No. 19 Jiangsu Road, Qingdao, Shandong, 266002, China.
authors: Shougen
authors: S
authors: Cao
authors: Yanbing
authors: Y
authors: Zhou
authors: Dong
authors: D
authors: Chen
authors: Zhaojian
authors: Z
authors: Niu
authors: Dongsheng
authors: D
authors: Wang
authors: Liang
authors: L
authors: Lv
authors: Yu
authors: Y
authors: Li
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects; D006684:HLA-DR Antigens; D017052:Hospital Mortality; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology; D007003:Hypoglycemia / Q000139:chemically induced; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000276:immunology; D010288:Parenteral Nutrition / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology*; D013274:Stomach Neoplasms / Q000601:surgery*
chemical_list: D001786:Blood Glucose; D006684:HLA-DR Antigens; D007004:Hypoglycemic Agents; D007328:Insulin