Blood sugar control improves insulin resistance following liver surgery: Study
Sweden: Glucose control during liver surgery significantly reduces postoperative insulin resistance, reveal recent findings from a study in the journal Clinical Nutrition.
Postoperative insulin resistance and hyperglycemia is associated with negative patient's outcomes. Insulin resistance' magnitude can be modulated by various factors including minimal invasive surgery, adequate pain management, preoperative nutrition and blood sugar control. However, not much is known about the effects of blood sugar control on perioperative glucose in liver surgery.
Against the above background, Christina Blixt, Karolinska Institutet, Stockholm, Sweden, and colleagues hypothesized that by establishing perioperative glucose control of 6–8 mmol/l, they could diminish the postoperative insulin resistance and that the effect is mostly a result from a reduction in glucose production.
For this purpose, the researchers studied 18 patients scheduled for open hepatectomy per protocol. The treatment group (n=9) received intravenous insulin to keep arterial blood sugar between 6 and 8 mmol/l during surgery. The control group (n=9) received insulin if blood sugar >11.5 mmol/l.
Insulin sensitivity was measured by an insulin clamp on the day before surgery and immediately postoperatively. Glucose kinetics were assessed during the clamp and surgery.
Key findings of the study include:
· Mean intraoperative glucose was 7.0 mM vs 9.1 mM in the insulin and control group respectively.
· Insulin sensitivity decreased in both groups but significantly more in the control group (M value: 4.6 to 2.1 and 4.6 to 0.6 mg/kg/min in the treatment and control group respectively).
· Endogenous glucose production (EGP) increased and glucose disposal (WGD) decreased significantly between the pre- and post-operative clamps in both groups, with no significant difference between the groups.
· Intraoperative kinetics demonstrated that glucose control decreased EGP while WGD remained unchanged.
"Glucose control reduces postoperative insulin resistance in liver surgery. Endogenous glucose production (EGP) increases and glucose disposal (WGD) is diminished immediately postoperatively. Insulin seems to modulate both reactions, but mostly the glucose disposal (WGD) is affected. Intraoperative Endogenous glucose production (EGP) decreased while glucose disposal (WGD) remained unaltered," wrote the authors.
The study titled, "The effect of glucose control in liver surgery on glucose kinetics and insulin resistance," is published in the journal Clinical Nutrition.