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What is the optimal range of glycemic control for non-diabetic patients undergoing gastroenterological surgery? A single-center randomized controlled trial using an artificial pancreas.
Tanioka, Nobuhisa; Maeda, Hiromichi; Uemura, Sunao; Munekage, Masaya; Kitagawa, Hiroyuki; Namikawa, Tsutomu; Kuroiwa, Hajime; Fujimoto, Shimpei; Seo, Satoru; Hanazaki, Kazuhiro.
Afiliação
  • Tanioka N; Department of Surgery, Kochi Medical School Hospital, Kochi University, Nankoku, Japan.
  • Maeda H; Department of Surgery, Kochi Medical School Hospital, Kochi University, Nankoku, Japan.
  • Uemura S; Department of Gastrointestinal Surgery, Kochi Red Cross Hospital, Kochi, Japan.
  • Munekage M; Department of Surgery, Kochi Medical School Hospital, Kochi University, Nankoku, Japan.
  • Kitagawa H; Department of Surgery, Kochi Medical School Hospital, Kochi University, Nankoku, Japan.
  • Namikawa T; Department of Surgery, Kochi Medical School Hospital, Kochi University, Nankoku, Japan.
  • Kuroiwa H; Integrated Center for Advanced Medical Technologies (ICAM-Tech), Kochi Medical School Hospital, Kochi University, Nankoku, Japan.
  • Fujimoto S; Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School Hospital, Kochi University, Nankoku, Japan.
  • Seo S; Department of Surgery, Kochi Medical School Hospital, Kochi University, Nankoku, Japan.
  • Hanazaki K; Department of Surgery, Kochi Medical School Hospital, Kochi University, Nankoku, Japan.
Artif Organs ; 47(6): 943-950, 2023 Jun.
Article em En | MEDLINE | ID: mdl-37084125
BACKGROUND: This study aimed to determine the optimal target range of perioperative glycemic control for gastroenterological surgery. A closed-loop-type artificial pancreas (AP) was used to diminish the negative impact of hypoglycemia and glycemic variability during tight glycemic control. METHODS: In this single-center randomized trial, non-diabetic patients were assigned to tight (80-110 mg/dL) or moderate glycemic control (110-140 mg/dL) groups between August 2017 and May 2021. AP was used from the intraoperative period until discharge from the intensive care unit. The primary endpoint was the serum interleukin (IL)-6 level on the third postoperative day (3POD), and the secondary endpoints included clinical outcomes. RESULTS: Recruitment was closed before reaching the planned number of patients due to slow enrollment. Tight glycemic control (n = 62) resulted in lower mean glucose levels than moderate glycemic control (n = 66) (121.3 ± 10.8 mg/dL vs. 133.5 ± 12.0 mg/dL, p < 0.001). Insulin was administered at a 65% higher rate for tight glycemic control, achieving appropriate glucose control more than 70% of the treatment time. No hypoglycemia occurred during the AP treatment. No significant difference was observed in serum IL-6 levels on 3POD (23.4 ± 31.1 vs. 32.1 ± 131.0 pg/mL, p = 0.64), morbidity rate, surgical mortality rate, or length of hospital stay between the two groups. CONCLUSIONS: Clinically relevant short-term results did not differ, implying that 80-110 and 110-140 mg/dL are permissible glycemic control ranges when using AP in non-diabetic patients undergoing gastroenterological surgery. (Registered in UMIN; UMIN000028036).
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Pâncreas Artificial / Hipoglicemia Limite: Humans Idioma: En Ano de publicação: 2023

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Pâncreas Artificial / Hipoglicemia Limite: Humans Idioma: En Ano de publicação: 2023