Randomized Clinical Trial
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2022; 10(18): 6082-6090
Published online Jun 26, 2022. doi: 10.12998/wjcc.v10.i18.6082
Impact of preoperative carbohydrate loading on gastric volume in patients with type 2 diabetes
Xin-Qiang Lin, Yu-Ren Chen, Xiao Chen, Yu-Ping Cai, Jian-Xin Lin, De-Ming Xu, Xiao-Chun Zheng
Xin-Qiang Lin, Department of Anesthesiology, Affiliated Hospital of Putian College, Putian Maternity and Child Care Hospital, Putian 351100, Fujian Province, China
Yu-Ren Chen, Xiao Chen, Yu-Ping Cai, Jian-Xin Lin, De-Ming Xu, Department of Anesthesiology, Affiliated Hospital of Putian College, Putian 351100, Fujian Province, China
Xiao-Chun Zheng, Department of Anesthesiology, Shenli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou 350001, Fujian Province, China
Author contributions: All authors contributed to the study conception and design; Zheng XC designed the study; Material preparation, data collection and analysis were performed by Lin XQ, Chen YR and Chen X; Cai YP, Lin JX and Xu DM contributed sample collection and intellectual input; The first draft of the manuscript was written by Lin XQ and all authors commented on previous versions of the manuscript; All authors read and approved the final manuscript; Lin XQ and Chen YR contributed equally to this study.
Supported by Natural Science Foundation of Fujian Province, No. 2019J01587.
Institutional review board statement: The present study was approved by the Ethics Committee of Putian College Affiliated Hospital, No. 201936.
Clinical trial registration statement: This study is registered at the Chinese Clinical trial registry, No. ChiCTR1900028529.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: The datasets generated during and/or analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Chun Zheng, MD, Professor, Department of Anesthesiology, Shenli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, No. 134 East Street, Fuzhou 350001, Fujian Province, China. zhengxiaochun2021@163.com
Received: December 22, 2021
Peer-review started: December 22, 2021
First decision: February 8, 2022
Revised: March 21, 2022
Accepted: April 21, 2022
Article in press: April 21, 2022
Published online: June 26, 2022
Processing time: 176 Days and 11.4 Hours
Abstract
BACKGROUND

Enhanced recovery after surgery advocates that consuming carbohydrates two hours before anesthesia is beneficial to the patient's recovery. Patients with diabetes are prone to delayed gastric emptying. Different guidelines for preoperative carbohydrate consumption in patients with diabetes remain controversial due to concerns about the risk of regurgitation, aspiration and hyperglycemia. Ultrasonic gastric volume (GV) assessment and blood glucose monitoring can comprehensively evaluate the safety and feasibility of preoperative carbohydrate intake in type 2 diabetes (T2D) patients.

AIM

To evaluate the impact of preoperative carbohydrate loading on GV before anesthesia induction in T2D patients.

METHODS

Patients with T2D receiving surgery under general anesthesia from December 2019 to December 2020 were included. A total of 78 patients were randomly allocated to 4 groups receiving 0, 100, 200, or 300 mL of carbohydrate loading 2 h before anesthesia induction. Gastric volume per unit weight (GV/W), Perlas grade, changes in blood glucose level, and risk of reflux and aspiration were evaluated before anesthesia induction.

RESULTS

No significant difference was found in GV/W among the groups before anesthesia induction (P > 0.05). The number of patients with Perlas grade II and GV/W > 1.5 mL/kg did not differ among the groups (P > 0.05). Blood glucose level increased by > 2 mmol/L in patients receiving 300 mL carbohydrate drink, which was significantly higher than that in groups 1 and 2 (P < 0.05).

CONCLUSION

Preoperative carbohydrate loading < 300 mL 2 h before induction of anesthesia in patients with T2D did not affect GV or increase the risk of reflux and aspiration. Blood glucose levels did not change significantly with preoperative carbohydrate loading of < 200 mL. However, 300 mL carbohydrate loading may increase blood glucose levels in patients with T2D before induction of anesthesia.

Keywords: Type 2 diabetes; Preoperative; Carbohydrate loading; Gastric volume; Ultrasound assessment; Hyperglycemia

Core Tip: Enhanced recovery after surgery advocates that consuming carbohydrates two hours before anesthesia is beneficial to the patient's recovery. Patients with diabetes are prone to delayed gastric emptying. Different guidelines for preoperative carbohydrate consumption in patients with diabetes remain controversial due to concerns about the risk of regurgitation, aspiration and hyperglycemia. In this study, the preoperative carbohydrate load of type 2 diabetes (T2D) patients 2 h before anesthesia induction was found by ultrasonic gastric volume assessment and blood glucose monitoring. 200 mL does not increase the risk of reflux, aspiration, and hyperglycemia, but 300 mL glucose load may cause hyperglycemia in T2D patients before induction of anesthesia.