Pre-operative carbohydrate loading may be used in type 2 diabetes patients
Pre-operative carbohydrate loading may be used in type 2 diabetes patients
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DOI：
10.1111/j.1399-6576.2008.01599.x
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发表时间：
2008-08-01
影响因子：
2.1
通讯作者：
Hagstrom-Toft, E.
中科院分区：
文献类型：
--
作者：
Gustafsson, U. O.;Nygren, J.;Hagstrom-Toft, E.
背景：术后胰岛素抵抗和高血糖症与术后预后受损相关。术前口服碳水化合物负荷（CHO）可降低术后胰岛素抵抗，并降低术后营养期间高血糖的风险。胰岛素抵抗的糖尿病患者尚未给予CHO，因为对术前血糖和胃排空的影响是unknown. Methods：25例（45 - 73岁）2型糖尿病患者[糖化血红蛋白（HbA1c）6.2 +/-0.2%，平均+/-SEM]和10名健康对照组（45 - 72岁）进行了研究。结果：糖尿病患者的峰值葡萄糖高于健康受试者（13.4 +/-0.5 vs. 7.6 +/-0.5 mM; P <0.01），并且在摄入后较晚出现（60 vs. 30 min; P <0.01）。糖尿病患者和健康受试者的血糖浓度分别在180和120 min时恢复至基线水平（P <0.01）。120 min时，糖尿病患者和健康受试者胃中分别残留10.9 +/-0.7%和13.3 +/-1.2%的对乙酰氨基酚。糖尿病患者胃半排空时间（T50）为49.8 ± 2.2 min，健康人为58.6 ± 3.7 min（P <0.05）。胰岛素组和对照组之间的峰值葡萄糖、180 min时的葡萄糖、胃T50和120 min时的滞留均无差异。（HbA1c 6.8 +/-0.7%）-和非胰岛素治疗（HbA1c 5.6 +/-0.4%）患者。结论：2型糖尿病患者没有表现出胃排空延迟的迹象，这表明富含碳水化合物的饮料可以在麻醉前180分钟安全地给药，而没有高血压或术前吸入的风险。
Background: Post-operative insulin resistance and hyperglycaemia are associated with an impaired outcome after surgery. Pre-operative oral carbohydrate loading (CHO) reduces post-operative insulin resistance with a reduced risk of hyperglycaemia during post-operative nutrition. Insulin-resistant diabetic patients have not been given CHO because the effects on pre-operative glycaemia and gastric emptying are unknown.Methods: Twenty-five patients (45-73 years) with type 2 diabetes [glycated haemoglobin (HbA1c) 6.2 +/- 0.2%, mean +/- SEM] and 10 healthy control subjects (45-72 years) were studied. A carbohydrate-rich drink (400 ml, 12.5%) was given with paracetamol 1.5 g for determination of gastric emptying.Results: Peak glucose was higher in diabetic patients than in healthy subjects (13.4 +/- 0.5 vs. 7.6 +/- 0.5 mM; P < 0.01) and occurred later after intake (60 vs. 30 min; P < 0.01). Glucose concentrations were back to baseline at 180 vs. 120 min in diabetic patients and healthy subjects, respectively (P < 0.01). At 120 min, 10.9 +/- 0.7% and 13.3 +/- 1.2% of paracetamol remained in the stomach in diabetic patients and healthy, subjects respectively. Gastric half-emptying time (T50) occurred at 49.8 +/- 2.2 min in diabetics and at 58.6 +/- 3.7 min in healthy subjects (P < 0.05). Neither peak glucose, glucose at 180 min, gastric T50, nor retention at 120 min differed between insulin (HbA1c 6.8 +/- 0.7%)- and non-insulin-treated (HbA1c 5.6 +/- 0.4%) patients.Conclusions: Type 2 diabetic patients showed no signs of delayed gastric emptying, suggesting that a carbohydrate-rich drink may be safely administrated 180 min before anaesthesia without risk of hyperglycaemia or aspiration pre-operatively.