Analysis of perioperative glucose metabolism using an artificial pancreas.
Adult
Aged
Aged, 80 and over
Biomarkers
/ blood
Blood Glucose
/ metabolism
Female
Hepatectomy
Humans
Insulin Infusion Systems
Insulin Resistance
Male
Middle Aged
Monitoring, Physiologic
Pancreas, Artificial
Pancreaticoduodenectomy
Perioperative Care
Postoperative Complications
/ blood
Prospective Studies
Risk Factors
Sarcopenia
/ blood
artificial pancreas
hepato-biliary-pancreatic surgery
insulin resistance
perioperative glucose metabolism
sarcopenia
Journal
Artificial organs
ISSN: 1525-1594
Titre abrégé: Artif Organs
Pays: United States
ID NLM: 7802778
Informations de publication
Date de publication:
Sep 2021
Sep 2021
Historique:
revised:
30
03
2021
received:
25
11
2020
accepted:
31
03
2021
pubmed:
6
4
2021
medline:
5
1
2022
entrez:
5
4
2021
Statut:
ppublish
Résumé
Hyperglycemia associated with insulin resistance is common in surgical patients with and without diabetes and is associated with poor surgical outcomes. Several studies have recently shown that a closed-loop blood glucose monitoring system in the form of an artificial pancreas is safe and effective for surgical patients. In this study, we analyzed the risk factors for insulin resistance in patients using an artificial pancreas. We investigated 109 patients who underwent surgical management by an artificial pancreas for 24 hours from the start of surgery during either major hepatectomy (MH), defined as resection of more than two liver segments, or pancreaticoduodenectomy (PD). The target glucose range was from 80 to 110 mg/dL using an artificial pancreas. We analyzed the risk factors for and predictors of a high insulin dose, including sarcopenia markers, according to the median 24-hour total insulin infusion. The median total insulin dose and glycemic control rate (GCR), which is the rate of achieving the target blood glucose range, per 24 hours were 78.0 IU and 30.4% in the MH group and 82.6 IU and 23.5% in the PD group, respectively. The muscle volume was the only independent factor in the high-dose subgroup, and the GCR was significantly lower in the high-dose subgroup despite a high insulin dose in both the MH and PD groups. The results of this study suggest that preoperative sarcopenia is closely associated with insulin resistance in the perioperative period. Clinicians must effectively manage sarcopenia, which may result in improved perioperative glycemic control and reduced postoperative complications.
Substances chimiques
Biomarkers
0
Blood Glucose
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
998-1005Informations de copyright
© 2021 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.
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