Pre-operative Carbohydrate Loading in Enhanced Recovery After Surgery Protocols is Safe in Type II Diabetics
Stephanie D. Talutis1, Su Yeon Lee1, Daniel Cheng2, Pamela Rosenkranz1, Sara M. Alexanian1, David McAneny1
1Boston Medical Center, Boston, MA, USA; 2University of Nevada, Las Vegas, NV, USA
Background: Enhanced Recovery After Surgery(ERAS) protocols include pre-operative carbohydrate beverage(CHO) to reduce nitrogen and protein losses, decrease post-operative nausea, and minimize ileus. The objective was to determine safety of CHO consumption in ERAS protocols among patients with Type II diabetes(DMII).
Methods: Retrospective chart review of patients who consumed CHO as part of ERAS protocol during 10/1/15-9/30/16. Patients with diet-controlled DMII and those on scheduled antiemetics were excluded. 355 patients met inclusion criteria(80 DMII, 275 non-diabetics). 89 historical DMII patients from the preceding year were included for comparison. Insulin requirements, inpatient endocrine consultations, hypoglycemic episodes, and post-operative complications were compared using ANOVA. Significance defined as p <0.05.
Results: ERAS patients, with and without DMII, were similar to historical DMII patients(Table). There were no differences in hemoglobin A1C or number of pre-operative DMII medications between DMII groups. Significant difference was observed in median glucose measurements on POD 1 for DMII patients(ERAS 152 vs Historical 137.5, p=0.004). There were no differences in perioperative glucose measurements, perioperative insulin dosing, intraoperative insulin infusion use, hypoglycemic episodes, or inpatient endocrine consultations. DMII patients did not have an increased incidence of complications. Complications were not influenced by number of DMII medications(OR 1.316, CI(0.489, 3.537)), A1C(0.642(0.372, 1.109)), pre-operative glucose(1.008(0.993, 1.204)), or home insulin dosage(0.983(0.958, 1.009)).
Conclusion: Patients with DMII safely tolerated CHO in an ERAS protocol without increasing insulin requirements or increased complications.
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