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The Quality of Preoperative Glycemic Control Predicts Insulin Sensitivity During Major Upper Abdominal Surgery: A

Keisuke Omiya1, Hiroaki Sato1, Tamaki Sato1

  • 1From the Department of Anesthesia, McGill University Health Centre Glen Site, Royal Victoria Hospital, Montreal, QC, Canada.

Annals of Surgery Open : Perspectives of Surgical History, Education, and Clinical Approaches
|August 21, 2023
PubMed

Insights

Poor preoperative glycemic control and higher BMI are linked to reduced insulin sensitivity during hepatectomy. This insulin resistance is associated with increased postoperative complications, highlighting the importance of metabolic health in surgical outcomes.

Area of Science:

  • Metabolic Surgery
  • Surgical Endocrinology
  • Clinical Nutrition

Background:

  • Glycated hemoglobin A1c (HbA1c) reflects 3-month glycemic control and is linked to intraoperative insulin sensitivity in cardiac surgery.
  • Insulin resistance is a significant predictor of adverse clinical outcomes in surgical patients.

Purpose of the Study:

  • To investigate the association between preoperative glycemic control quality and intraoperative insulin sensitivity during major upper abdominal surgery (hepatectomy).
  • To explore the relationship between insulin sensitivity, body mass index (BMI), and postoperative morbidity.

Main Methods:

  • A post hoc analysis of a randomized controlled trial involving elective hepatectomy patients.
  • The hyperinsulinemic-normoglycemic clamp (HNC) technique was used to measure insulin sensitivity immediately before skin incision.
  • Insulin sensitivity was determined by the steady-state dextrose infusion rate during the HNC procedure.

Main Results:

  • A negative correlation was observed between preoperative HbA1c levels and insulin sensitivity (R² = 0.29).
  • Body mass index (BMI) also showed a negative correlation with insulin sensitivity (R² = 0.43).
  • Increased insulin sensitivity was significantly associated with a reduced risk of postoperative complications within 30 days (OR = 0.22, P = 0.009).

Conclusions:

  • Preoperative glycemic control and BMI significantly influence insulin sensitivity during hepatectomy.
  • The degree of insulin resistance is a key factor correlating with postoperative morbidity in these patients.
Abstract

Keywords:
body mass indexdiabetesglycated hemoglobin A1cintraoperative insulin sensitivitypostoperative morbidity

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