title: Intensive Versus Conventional Glycemic Control in Patients with Diabetes During Enteral Nutrition After Gastrectomy.
abstract: BACKGROUND
  This study compared intensive and conventional glycemic management strategies in diabetic patients receiving enteral nutrition after gastrectomy.
  
  
  METHODS
  Diabetic patients (n = 212) who underwent gastrectomy between September 2006 and March 2014 were randomized to intensive glycemic (IG) management with continuous insulin infusion (target glucose 4.4-6.1 mmol/l (80-110 mg/dl)) or conventional glycemic (CG) management with intermittent bolus insulin (target glucose <11.1 mmol/l (<200 mg/dl)). Outcomes included blood glucose concentrations, insulin administration, and postoperative morbidity and mortality.
  
  
  RESULTS
  Blood glucose levels were lower (5.4 ± 1.2 vs. 9.5 ± 1.8 mmol/l, P < 0.001) and mean insulin dose was higher (55 ± 15 vs.32 ± 16 units/day, P < 0.001) in the IG than in the CG group. Rates of severe hypoglycemia (7.5 vs. 0.9%, P = 0.035) and achievement of target blood glucose (86.3 vs. 72.6%, P = 0.023) were higher, while severe hyperglycemia rate was lower (1.9 vs. 11.3%, P = 0.010), in the IG group. Surgical site infection rate was lower in the IG group (4.7 vs. 13.2%, P < 0.030). Rates of other infective complications, bleeding, delayed gastric emptying, obstruction, hepatic dysfunction, renal dysfunction, and circulatory insufficiency were similar in the two groups.
  
  
  CONCLUSIONS
  Intensive glycemic control in diabetic patients receiving enteral nutrition after gastrectomy was associated with a lower surgical site infection rate but a higher hypoglycemia rate.
authors.affiliation: Department of Laparoscopic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
authors.forename: Jiaxiang
authors.initials: J
authors.lastname: Yuan
authors.forename: Tao
authors.initials: T
authors.lastname: Liu
authors.forename: Xiefu
authors.initials: X
authors.lastname: Zhang
authors.forename: Yaqing
authors.initials: Y
authors.lastname: Si
authors.forename: Yanwei
authors.initials: Y
authors.lastname: Ye
authors.forename: Chunlin
authors.initials: C
authors.lastname: Zhao
authors.forename: Qun
authors.initials: Q
authors.lastname: Wang
authors.forename: Xinsheng
authors.initials: X
authors.lastname: Shen
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D002276:Carcinoid Tumor / Q000150:complications / Q000601:surgery*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D004750:Enteral Nutrition; D005260:Female; D005743:Gastrectomy; D046152:Gastrointestinal Stromal Tumors / Q000150:complications / Q000601:surgery*; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D007889:Leiomyoma / Q000150:complications / Q000601:surgery*; D008223:Lymphoma / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology; D013274:Stomach Neoplasms / Q000150:complications / Q000601:surgery*
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin