Perioperative intensive insulin therapy using an artificial endocrine pancreas with closed-loop glycemic control system: the effects of no hypoglycemia.
BACKGROUND
We examined whether perioperative intensive insulin therapy (IIT) using an artificial pancreas (AP) with a closed-loop glycemic control system can be used to prevent hypoglycemia in surgical patients.


METHODS
Between 2006 and 2012, perioperative glycemic control using an AP was performed in 427 patients undergoing general surgery. A total of 305 patients undergoing IIT using an AP in the target blood glucose range of 80 to 110 mg/dL were enrolled in the study. Data were collected prospectively and were reviewed or analyzed retrospectively.


RESULTS
No patients had hypoglycemia. Perioperative mean blood glucose level and achievement rates in target blood glucose range of 80 to 110 mg/dL were 100.5 ± 11.9 mg/dL and 88.1% ± 16.0%, respectively. For the 3 primary operative methods, including hepatic, pancreatic, and esophageal resections, there were no significant differences in glycemic control stability between the types of surgery.


CONCLUSIONS
Perioperative IIT using an AP with a closed-loop glycemic control system can be used to prevent hypoglycemia and maintain stable glycemic control with less variability of blood glucose concentration.
Department of Surgery, Kochi Medical School, Kochi University, Kohasu, Okocho, Nankoku-City, Kochi 783-8505, Japan. Electronic address: hanazaki@kochi-u.ac.jp.
Kazuhiro
K
Hanazaki
Department of Surgery, Kochi Medical School, Kochi University, Kohasu, Okocho, Nankoku-City, Kochi 783-8505, Japan.
Hiroyuki
H
Kitagawa
Department of Anesthesiology, Kochi Medical School, Kochi University, Kohasu, Okocho, Nankoku-City, Kochi 783-8505, Japan.
Tomoaki
T
Yatabe
Department of Surgery, Kochi Medical School, Kochi University, Kohasu, Okocho, Nankoku-City, Kochi 783-8505, Japan.
Masaya
M
Munekage
Department of Surgery, Kochi Medical School, Kochi University, Kohasu, Okocho, Nankoku-City, Kochi 783-8505, Japan.
Ken
K
Dabanaka
Department of Surgery, Kochi Medical School, Kochi University, Kohasu, Okocho, Nankoku-City, Kochi 783-8505, Japan.
Yuka
Y
Takezaki
Department of Surgery, Kochi Medical School, Kochi University, Kohasu, Okocho, Nankoku-City, Kochi 783-8505, Japan; Nikkiso Co. Ltd., Tokyo, Japan.
Yuuki
Y
Tsukamoto
Nikkiso Co. Ltd., Tokyo, Japan.
Takuji
T
Asano
Nikkiso Co. Ltd., Tokyo, Japan.
Yoshihiko
Y
Kinoshita
Department of Surgery, Kochi Medical School, Kochi University, Kohasu, Okocho, Nankoku-City, Kochi 783-8505, Japan.
Tsutomu
T
Namikawa
D001786:Blood Glucose / Q000032:analysis; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000517:prevention & control*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D019397:Pancreas, Artificial; D019990:Perioperative Care; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative; D016896:Treatment Outcome
D001786:Blood Glucose; D007328:Insulin
Artificial pancreas; Closed-loop glycemic control system; Hypoglycemia; Perioperative intensive insulin therapy; Stable glycemic control