Minireviews
Copyright ©The Author(s) 2023.
World J Diabetes. Jun 15, 2023; 14(6): 783-794
Published online Jun 15, 2023. doi: 10.4239/wjd.v14.i6.783
Table 1 Glycemic variability: Clinical relevance
Ref.
Patient population
Variability index
Reported results
Egi et al[13], 20067049 ICU patients, DM includedICU survivors vs ICU non-survivors
SDSD: 1.7 vs 2.3 mmol/L, P < 0.001
CVCV: 20 vs 26%, P < 0.001
Ali et al[14], 20081246 patients with sepsis, DM includedMortality crude odds ratio, 95%CI
GLIGLI: 1.25, 1.20-1.32, P < 0.001
MAGEMAGE: 1.12, 1.07-1.18, P < 0.001
SDSD: 1.16, 1.11-1.21, P < 0.001
Donati et al[15], 20141641 ICU patients, DM includedICU survivors vs ICU non-survivors
SDSD: 1.4 vs 1.7 mmol/L, P < 0.001
CVCV: 21 vs 23%, P < 0.001
GLIGLI: 50.1 vs 75.6 (mmol/L)2/h/wk, P < 0.001
MAGEMAGE: 2.4 vs 2.7 mmol/L, P < 0.001
No infection vs ICU-acquired infection
SDSD: 1.4 vs 1.6 mmol/L, P < 0.001
CVCV: 20 vs 23%, P < 0.001
GLIGLI: 44.6 vs 73.5 (mmol/L) 2/h/wk, P < 0.001
MAGEMAGE: 2.3 vs 2.7 mmol/L, P < 0.001
Akirov et al[16], 20198894 surgical patients, DM includedHospital LOS: Low GV vs High GV
SDDM SD: 7 vs 9 d, P < 0.001
SDNo DM SD: 7 vs 9 d, P < 0.001
CVDM CV: 7 vs 9 d, P < 0.001
CVNo DM: CV 7 vs 9 d, P < 0.001
30 d mortality: Low GV vs High GV
SDDM SD: 5% vs 8%, P < 0.05
SDNo DM SD: 3% vs 9%, P < 0.05
CVDM CV: 5% vs 9%, P < 0.05
CVNo DM CV: 3% vs 9%, P < 0.05
ICU: Intensive care unit; DM: Diabetes mellitus; CV: Coefficient of variance; GLI: Glycemic lability index; MAGE: Mean amplitude of glycemic excursion; LOS: Length of stay; GV: Glycemic variability.
Table 2 Perioperative glycemic variability and postoperative course
Ref.
Patient population
Variability index
Reported results
Subramaniam et al[18], 20141461 cardiac surgery patients, DM includedCVNo MAE vs MAE
CV: 21% vs 24%, P = 0.001
HbA1c < 6.5% vs > 6.5%
CV: 20% vs 26%, P < 0.001
Shohat et al[19], 20185058 patients for total joint arthroplastyCV1st tertile of CV vs 3rd tertile of CV
Mortality: 0.1% vs 0.4%, P = 0.06
PPJI: 0.5% vs 0.9%, P = 0.02
SSI: 1% vs 1.4%, P = 0.03
Reop: 1.6% vs 1.5%, P = 0.83
Patel et al[20], 2021264 patients for cervical spine surgeryCV1st tertile of CV vs 3rd tertile of CV
Complication: 12.5% vs 20.4%, P = 0.37
Hospital LOS: 3.9 vs 6.06 d, P = 0.01
Readmission: 3.4% vs 7.8%, P = 0.03
SSI: 1.1% vs 9.5%, P = 0.04
Reop: 0.4% vs 3.8%, P = 0.19
DM: Diabetes mellitus; CV: Coefficient of variance; MAE: Major adverse event; MI: Myocardial infarction; Reop: Reoperation; DSWI: Deep sternal wound infection; CVA: Cerebrovascular accident; PNA: Pneumonia; PPJI: Periprosthetic joint infection; SSI: Surgical site infection.
Table 3 Preoperative carbohydrate load: Impact on glycemic variability and surgical outcomes
Ref.
Patient population
PCL composition and timing
Reported conclusion
Singh et al[22], 2015120 same-day surgery patients, DM excluded12.5% CHO, 500 kcal/L; 400 mL before MN + 200 mL 2 h before surgeryIntervention vs placebo vs control
Nausea score
0-4 h: 0.65 vs 1.30 vs 1.23, P = 0.001
4-12 h: 0.70 vs 0.83 vs 1.05, P = 0.066
12-24 h: 0.25 vs 0.43 vs 0.35, P = 0.257
Vomit incidence
0-4 h: 17.5% vs 42.5% vs 47.5%, P (I-P) ≤ 0.001, P (I-C) = 0.004
4-12 h: 7.5% vs 12.5% vs 32.5%, P (I-P) = 0.459, P (I-C) = 0.005
12-24 h: 0% vs 2.5% vs 2.5%, P (I-P) = 0.314, P (I-C) = 0.314
Pain score
0-4 h: 5.75 vs 7.13 vs 6.95, P = 0.001
4-12 h: 3.53 vs 4.08 vs 4.65, P = 0.005
12-24 h: 1.95 vs 2.08 vs 2.25, P = 0.223
Gianotti et al[23], 2018662 patients undergoing elective major abdominal surgery, DM excluded12.6% CHO, 500 kcal/L; 800 mL between 8 pm and 2 h before surgeryIntervention vs placebo
Composite infection: 16.3% vs 16.0%, P = 1.00
Insulin requirement: 2.4% vs 16%, P < 0.001
Antibiotic therapy: 30.8% vs 29.9%, P = 0.87
Total complications: 28.1% vs 28.4%, P = 1.00
Hospital LOS: 11 vs 11 d, P = 0.44
Aspiration events: 0 vs 0, P = 1.00
Liu et al[24], 2019120 patients undergoing elective craniotomy, DM excluded12.5% CHO, 500 kcal/L; 400 mL 2 h before surgeryIntervention vs control
Preop BGC: 6.3 vs 5.6 mmol/L, P = 0.020
POD3 BGC: 5.6 vs 6.3 mmol/L, P = 0.001
POD3 handgrip: 25.3 vs 19.9 kg, P < 0.0001
POD3 PEFR: 315.8 vs 270.0 L/min, P = 0.036
Postop LOS: 4 vs 7 d, P < 0.0001
Talutis et al[25], 2020169 patients with DM2 undergoing elective major abdominal surgery55 g CHO in 32 oz (946.35 mL), 5.8% CHO; 16 oz (473 mL) before MN + 16 oz 2 h before surgeryIntervention vs control
Preop BGC: 142 vs 129.5 mg/dL, P = 0.017
1st postop BGC: 159 vs 173 mg/dL, P = 0.23
POD1 BGC: 152 vs 137.5 mg/dL, P = 0.004
Intraop insulin: 0-16 vs 0-19 units, P = 0.63
POD1 insulin: 0-75 vs 0-79 units, P = 0.09
Complication rate: 20% vs 27%, P = 0.65
Hospital LOS: 2 vs 2 d, P = 0.38
Aspiration events: 0 vs 0, P = 1.00
Suh et al[26], 2021134 patients undergoing bariatric surgery, DM2 included50 g CHO in 296 mL, 16.9% CHO, 682 kcal/L; 296 mL before MN + 296 mL 3 h before surgeryIntervention vs control
Hospital LOS: 2.0 vs 2.1 d, P = 0.65
PONV score: 13.8 vs 15.4, P = 0.77
BGC: 140.7 vs 135.3 mg/dL, P = 0.34
Antiemetics: 5.3 vs 6 doses, P = 0.43
Readmission: 4.7% vs 5.7%, P = 0.79
Complication: 3.1% vs 4.3%, P = 0.72
Aspiration events: 0 vs 0, P = 1.00
Lee et al[27], 202246 patients with DM2 undergoing elective total joint arthroplasty12.8% CHO, 500 kcal/mL; 400 mL 2-3 h before anesthesiaIntervention vs control
CV: 16.5% vs 10.1%, P = 0.008
J index: 25.3 vs 18.9, P = 0.046
HOMA-IR: 8.5 vs 2.7, P < 0.001
Hospital LOS: 3 vs 3 d, P = 0.516
Nausea: 46% vs 29%, P = 0.402
Vomiting: 32% vs 8%, P = 0.066
Hypotension: 5% vs 13%, P = 0.609
Delirium: 18% vs 0%, P = 0.045
Wound dehiscence: 9% vs 8%, P = 0.999
Pain score at 6 h: 2 vs 2, P = 0.725
PCL: Preoperative carbohydrate load; DM: Diabetes mellitus; CHO: Carbohydrate; MN: Midnight; LOS: Length of stay; BGC: Blood glucose concentration; Preop: Preoperative; POD: Postoperative day; PEFR: Peak expiratory flow rate; postop: Postoperative; DM2: Type 2 diabetes mellitus; ERAS: Enhanced recovery after surgery; intraop: Intraoperative; PONV: Postoperative nausea and vomiting; CV: Coefficient of variance; HOMA-IR: Homeostasis Model Assessment Insulin Resistance.