title: Insulin sensitivity and beta-cell function after carbohydrate oral loading in hip replacement surgery: a double-blind, randomised controlled clinical trial.
abstract: OBJECTIVE
  Surgery initiates a series of physiological stress processes in the body, inducing transient insulin resistance. Preoperative carbohydrate treatment can reduce the latter phenomenon. We investigated the effects of carbohydrate loading on insulin sensitivity and beta-cell function after elective hip replacement.
  
  
  METHODS
  Twenty-three nondiabetic patients (mean age of 68 years) who underwent elective hip replacement surgery participated in this double-blind controlled study. The patients were randomised to a nutrition group, which ingested a carbohydrate-rich fluid (50 kcal/100 ml) (Preop(®)), or a control group (tap water flavoured with lemon) 800 ml + 400 ml before the surgery. The insulin response (beta-cell function) and the insulin sensitivity were measured with an intravenous glucose tolerance test (IVGTT) and a hyperinsulinaemic euglycaemic glucose clamp, respectively, one day before and two days after the surgery.
  
  
  RESULTS
  Insulin sensitivity decreased by 51% (median; 25-75th percentiles 35-61) after ingesting Preop(®) and by 39% (21-51) after ingesting in the control group (n.s.). The postoperative IVGTT in the nutrition group was followed by a significantly larger area under the curve (AUC) for plasma insulin (+54% versus the preoperative IVGTT) compared to the control group (+7%). This difference was already apparent during the first phase (0-10 min) of insulin secretion (+20 and -21%, respectively; P < 0.05).
  
  
  CONCLUSIONS
  The patients randomised to the carbohydrate oral fluid or the water prior to the surgery demonstrated a significant but similar decrease in insulin sensitivity. The carbohydrates increased the beta-cell function as a compensatory response to the disposition index, resulting in a smaller reduction in surgery-induced insulin resistance compared to the tap water. The study was registered at http://www.clinicaltrials.gov (NCT01774084).
authors.affiliation: Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden; Research Unit, Södertälje Hospital, Södertälje, Sweden.
authors.forename: Stefan
authors.initials: S
authors.lastname: Ljunggren
authors.affiliation: Research Unit, Södertälje Hospital, Södertälje, Sweden; Department for Anesthesia, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Hahn
authors.affiliation: Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden; Department for Endocrinology and Diabetology, Södersjukhuset, Stockholm, Sweden. Electronic address: Thomas.nystrom@sodersjukhuset.se.
authors.forename: Thomas
authors.initials: T
authors.lastname: Nyström
mesh_terms: D000284:Administration, Oral; D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D001786:Blood Glucose / Q000378:metabolism; D004040:Dietary Carbohydrates / Q000008:administration & dosage*; D004311:Double-Blind Method; D017558:Elective Surgical Procedures / Q000379:methods; D005260:Female; D015309:Glucose Clamp Technique; D005951:Glucose Tolerance Test; D006801:Humans; D007328:Insulin / Q000097:blood / Q000378:metabolism; D007333:Insulin Resistance; D000078790:Insulin Secretion; D050417:Insulin-Secreting Cells / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011300:Preoperative Care / Q000379:methods; D057234:Preoperative Period
chemical_list: D001786:Blood Glucose; D004040:Dietary Carbohydrates; D007328:Insulin
keywords: Beta-cell function; Carbohydrate oral fluid; Euglycaemic hyperinsulinaemic clamp; Hip replacement; Insulin resistance