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BACKGROUND: Perioperative hyperglycemia is common during cardiac surgery and has been linked to an increased risk of surgical site infections (SSIs). However, the benefits of perioperative tight glucose control (TGC) remain debated, largely due to concerns about hypoglycemia. This systematic review assessed the effects and safety of TGC on SSIs in adults undergoing cardiac surgery. METHODS: We searched MEDLINE, Embase, and Cochrane databases for randomized controlled trials (RCTs) comparing TGC (upper blood glucose target ≤150 mg/dL or 8.3 mmol/L) with conventional glucose management in adults undergoing cardiac surgery. The primary outcome was incidence of SSIs. Secondary outcomes included hypoglycemia, length of intensive care unit (ICU) stay, incidence of neurological deficits and all-cause mortality within 30 days after surgery. The certainty of evidence was evaluated using the GRADE approach. RESULTS: Twenty-six RCTs including 17,990 participants were analyzed. TGC compared with control group was associated with reducing the risk of SSIs (risk ratio [RR]: 0.53; 95 % confidence interval [CI]: 0.42-0.68; I2 = 0 %; low certainty evidence), particularly when initiated at the start of surgery (RR: 0.50, 95 %CI: 0.39-0.66, I2 = 0; low certainty evidence) but not postoperatively (RR = 0.80, 95 % CI: 0.39-1.66; I2 = 0; very low certainty evidence). TGC also shortened ICU stay by 7.03 h compared to the control group (95 % CI: -10.83 to -3.22; very low certainty evidence), though heterogeneity was considerable (I2 = 92 %). However, TGC was associated with a higher risk of hypoglycemia (RR: 3.14; 95 % CI: 2.37-4.16; I2 = 0; moderate certainty evidence). No significant effects were observed on neurological deficits or all-cause mortality. CONCLUSION: This systematic review of the available evidence suggests that perioperative TGC, particularly when initiated at the start of surgery, may reduce the risk of SSIs following cardiac surgery. However, it increases the risk of hypoglycemia and does not significantly impact neurological outcomes and all-cause mortality.
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Procedimientos Quirúrgicos Cardíacos , Control Glucémico , Hiperglucemia , Hipoglucemiantes , Atención Perioperativa , Infección de la Herida Quirúrgica , Humanos , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Ensayos Clínicos Controlados Aleatorios como Asunto , Infección de la Herida Quirúrgica/prevención & control , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/etiología , Atención Perioperativa/métodos , Atención Perioperativa/efectos adversos , Glucemia/análisis , Control Glucémico/métodos , Control Glucémico/efectos adversos , Hiperglucemia/prevención & control , Hiperglucemia/sangre , Hiperglucemia/etiología , Hipoglucemia/epidemiología , Hipoglucemia/inducido químicamente , Hipoglucemia/prevención & control , Hipoglucemiantes/efectos adversos , Hipoglucemiantes/administración & dosificación , Hipoglucemiantes/uso terapéutico , Tiempo de Internación/estadística & datos numéricos , IncidenciaRESUMEN
To evaluate whether a web-based Intraoperative Glycemic Protocol Calculator (IGPC) improves provider compliance with intraoperative glycemic management protocols during cardiac surgery. Single-center retrospective cohort study conducted between August - October 2022 (pre-intervention) and April - June 2023 (post-intervention). Tertiary care academic hospital. Adult patients undergoing coronary artery bypass grafting and/or valve surgery requiring cardiopulmonary bypass. Implementation of the IGPC, a web-based clinical decision support tool designed to automate insulin dosing recommendations intraoperatively. Protocol adherence, defined as appropriate insulin administration within five minutes of glucose measurement, was compared before and after IGPC implementation. Among 143 patients, IGPC use significantly increased adherence across all intraoperative phases: Pre-CPB (65.5% to 80.2%, p = 0.017), On-CPB (53.0% to 75.1%, p < 0.001), and Post-CPB (34.8% to 58.8%, p < 0.001). Rates of severe hypoglycemia remained low and unchanged (0.1% in both groups; p = 0.772), and intraoperative hyperglycemia rates were similar (4.2% vs. 4.1%; p = 0.995). Implementation of the IGPC significantly improved real-time adherence to intraoperative glycemic control protocols without increasing adverse glycemic events. However, rates of intraoperative hyperglycemia and hypoglycemia remained unchanged between the pre- and post-intervention phases. These findings highlight the utility of clinical decision support tools in enhancing protocol compliance during high-acuity cardiac surgeries.
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Glucemia , Control Glucémico , Monitoreo Intraoperatorio , Quirófanos , Humanos , Estudios Retrospectivos , Masculino , Femenino , Glucemia/análisis , Persona de Mediana Edad , Anciano , Hiperglucemia/prevención & control , Insulina/administración & dosificación , Insulina/uso terapéutico , Automatización , Puente de Arteria Coronaria , Monitoreo Intraoperatorio/métodos , Hipoglucemia , Sistemas de Apoyo a Decisiones Clínicas , Control Glucémico/métodos , Puente Cardiopulmonar , Procedimientos Quirúrgicos Cardíacos , Cuidados Intraoperatorios , Adhesión a DirectrizRESUMEN
Metabolic diseases such as high blood lipids, high blood sugar, and disrupted gut microbiota pose a serious threat to people's physical health. The occurrence of these diseases is closely related to the lack of nutrients in daily rice staple foods, but there is a lack of comprehensive analysis of the underlying mechanisms. This study used fully nutritious brown rice as raw material, and after germination under various stress conditions, it significantly increased the levels of gamma aminobutyric acid (GABA, four carbon non protein amino acid), resistant starch, flavonoids, and other components that regulate metabolic diseases. Using rats as experimental subjects, a model of hyperlipidemia and hyperglycemia was constructed, with rice consumption as the control. The experimental period was 8 weeks. Research has found that feeding sprouted brown rice can significantly improve the accumulation of white fat in the liver caused by a high-fat diet, significantly reduce TC, TG, LDL-C, apoB, HL, LPL, and LCAT, significantly increase HDL-C and apoA1, and significantly reduce the levels of inflammatory factors IL-6 and TNF-α. Therefore, consuming sprouted brown rice can reduce the risk of hyperlipidemia, inflammation, and tumor occurrence by promoting fat breakdown, and can also increase the abundance of metabolic-promoting microorganisms (especially Euryarchaeota and Lactobacillus) in the intestine, improving the entire metabolic ecological network of rats.
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Microbioma Gastrointestinal , Germinación , Hiperglucemia , Hiperlipidemias , Intestinos , Metabolismo de los Lípidos , Nutrientes , Oryza , Plantones , Nutrientes/administración & dosificación , Nutrientes/análisis , Oryza/química , Oryza/crecimiento & desarrollo , Oryza/metabolismo , Metabolismo de los Lípidos/genética , Animales , Ratas , Intestinos/microbiología , Ácido gamma-Aminobutírico/metabolismo , Aminoácidos/metabolismo , Hiperlipidemias/etiología , Hiperlipidemias/prevención & control , Hiperglucemia/etiología , Hiperglucemia/prevención & control , Hígado/metabolismo , Interleucina-6/sangre , Factor de Necrosis Tumoral alfa/sangre , Plantones/química , Plantones/crecimiento & desarrollo , Plantones/metabolismo , Euryarchaeota/crecimiento & desarrollo , Euryarchaeota/aislamiento & purificación , Lactobacillus/aislamiento & purificación , Dieta Alta en Grasa/efectos adversos , Modelos Animales de Enfermedad , Lípidos/sangre , Masculino , Ratas Sprague-DawleyRESUMEN
Background/Objectives: Postprandial hyperglycemia is a risk factor for diabetes and cardiovascular diseases, even in healthy individuals. Kanzaki mulberry leaf and water chestnut tea (MW tea), a blend of mulberry (Morus alba) leaves and water chestnut (Trapa japonica) leaves and husks, is rich in polyphenols and 1-deoxynojirimycin (DNJ) and may suppress postprandial glucose spikes, but evidence regarding its short-term daily intake is limited. This study aimed to evaluate the postprandial glycemic response and safety of two-week MW tea consumption using continuous glucose monitoring (CGM). Methods: We conducted a randomized, double-blind, placebo-controlled, two-period crossover trial involving 31 participants. Each intervention period lasted two weeks, separated by a one-week washout. Participants consumed either MW tea or a placebo before meals. Interstitial glucose levels were measured every 15 min using CGM. Postprandial glucose responses were recorded every 15 min for 180 min after a standardized meal on the first day of each period. The primary outcome was the coefficient of variation (CV) in glucose levels, calculated using data from the central 10 days of each intervention period. Safety was assessed using CGM-derived hypoglycemia metrics and blood test results. Results: The CV of glucose levels during the MW tea period was significantly lower than during the placebo period (mean difference: 0.02, p = 0.0006). A significant reduction in 1 h postprandial glucose area under the curve was also observed. No significant differences were found in hypoglycemia occurrence, liver/renal/inflammatory markers, or self-reported adverse symptoms. Notably, 1,5-anhydroglucitol (1,5-AG) levels significantly increased during MW tea intake, suggesting improved glycemic control. Conclusions: Short-term consumption of Kanzaki MW tea effectively suppressed postprandial glucose variability without safety concerns. These findings support MW tea as a promising natural supplement for glycemic management and the prevention of diabetes.
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Hiperglucemia , Morus , Extractos Vegetales , Periodo Posprandial , Té , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Glucemia/metabolismo , Glucemia/efectos de los fármacos , Estudios Cruzados , Método Doble Ciego , Hiperglucemia/prevención & control , Hiperglucemia/sangre , Morus/química , Hojas de la Planta/química , Té/químicaRESUMEN
BACKGROUND & AIMS: This study aimed to investigate the consequences of pre-operative dexamethasone administered to prevent post-operative pain and nausea on post-operative glycemic control and its influence on recovery. METHODS: A randomized controlled trial was conducted with hospitalized head and neck surgery patients receiving glucocorticoid premedication. Participants were randomized into intervention and control groups, and blood glucose was continuously monitored using the Freestyle Libre system. For hyperglycemia, insulin was administered per protocol in the intervention group but not in the control group. Secondary outcomes included muscle function, hydration, and recovery assessments. RESULTS: In 26 patients (21 % dropout rate), hyperglycemia (blood glucose (BG) ≥10 mmol/L) was observed in 54 % of patients. BG was correlated with age and duration of surgery, but normalized by small doses of rapid-acting insulin. Elevated p-C-peptide levels were associated with hyperglycemia. No significant differences between groups were found in maximum blood glucose, hospital stay, or readmissions. The intervention group showed significant muscle loss and poorer swallowing function but maintained functional ability in sit-to-stand tests. CONCLUSIONS: Postoperative hyperglycemia was common during head and neck surgery, but was normalized by small doses of insulin despite the indications of postoperative insulin resistance. The intervention was never activated, as the problems with postoperative insulin resistance were minor and less than expected despite the administration of preoperative dexamethasone. Accordingly, standard protocols do not seem indicated in the postoperative care of these patients, but frequent measurements of blood glucose are recommended. CLINICAL TRIALS REGISTRATION: NCT04021186.
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Glucemia , Control Glucémico , Cabeza , Hiperglucemia , Humanos , Masculino , Femenino , Glucemia/metabolismo , Glucemia/análisis , Dexametasona/administración & dosificación , Dexametasona/uso terapéutico , Persona de Mediana Edad , Hiperglucemia/tratamiento farmacológico , Hiperglucemia/prevención & control , Hiperglucemia/sangre , Hiperglucemia/etiología , Control Glucémico/métodos , Insulina/administración & dosificación , Insulina/uso terapéutico , Anciano , Adulto , Complicaciones Posoperatorias/prevención & control , Dolor Postoperatorio/prevención & control , Hipoglucemiantes/uso terapéutico , Periodo Posoperatorio , Glucocorticoides/administración & dosificación , Cabeza/cirugíaRESUMEN
BACKGROUND: Perioperative hyperglycemia is associated with adverse patient outcomes including surgical site infections. This study examined whether an automated insulin dosing reminder is associated with a lower risk for postoperative hyperglycemia and other secondary and safety outcomes in patients at high risk for intraoperative hyperglycemia. METHODS: The authors conducted a pragmatic trial using a sequential and repeated crossover design between October 5, 2022, and October 26, 2023. They sequentially assigned anesthesia providers to receive either an automated insulin dosing reminder (intervention) or a glucose check reminder (routine care) periodically throughout surgery for a consecutive sample of adult patients at high risk for intraoperative hyperglycemia undergoing major surgery at their quaternary medical center. The primary outcome was hyperglycemia (glucose greater than 180 mg/dl) at the first postoperative measurement 3 h or less postoperatively. The primary analysis studied the association between automated insulin dosing reminder and postoperative hyperglycemia adjusted for demographics, surgery characteristics, preoperative glucose, time period, and the interaction of intervention and time period. RESULTS: A total of 4,558 cases qualified for primary analysis: 2,611 cases in the routine care group and 1,947 cases in the intervention group. A total of 970 (37%) and 675 (35%) cases, respectively, experienced the primary outcome. The authors found no evidence of an association between treatment and postoperative hyperglycemia in the overall study period (odds ratio [OR], 0.90; 95% CI, 0.78 to 1.03; P = 0.165). There was no evidence of difference in intraoperative glucose monitoring (OR, 0.99; 95% CI, 0.83 to 1.19; P = 0.369) and intraoperative insulin use (OR, 1.00; 95% CI, 0.83 to 1.20; P = 0.995). The odds of surgical site infections were higher in the intervention group (overall unadjusted OR, 2.52; 95% CI, 1.37 to 4.64; P = 0.006). No difference in safety endpoints was observed between groups. CONCLUSIONS: Among surgical patients at high risk of intraoperative hyperglycemia, an automated insulin dosing reminder did not improve glycemic control or other outcomes compared with a glucose check reminder.
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Glucemia , Hiperglucemia , Hipoglucemiantes , Insulina , Atención Perioperativa , Humanos , Insulina/administración & dosificación , Masculino , Femenino , Persona de Mediana Edad , Glucemia/análisis , Glucemia/metabolismo , Glucemia/efectos de los fármacos , Atención Perioperativa/métodos , Atención Perioperativa/normas , Hiperglucemia/prevención & control , Hiperglucemia/tratamiento farmacológico , Hipoglucemiantes/administración & dosificación , Anciano , Estudios Cruzados , Adulto , Complicaciones Posoperatorias/prevención & controlRESUMEN
BACKGROUND: Postoperative hyperglycemia in diabetic patients is a widely known risk factor for postoperative infectious complications (PICs) after esophagectomy; however, the significance of glycemic control in non-diabetic patients is less clear. In diabetic patients, early postoperative management of esophagectomy favors low-carbohydrate enteral nutrition (EN) over standard EN to suppress the risk of glycemic spike. Our single-center, randomized phase II trial seeks to test the hypothesis that low-carbohydrate EN can suppress hyperglycemia in non-diabetic patients who undergo esophagectomy. Herewith we present the study protocol. METHODS: A total of 50 patients will be enrolled and randomly assigned (1:1 ratio) to standard or low-carbohydrate EN. Randomization will be stratified by operation time (≥560 vs. < 560 min) and HbA1c (6.0-6.4% vs. < 6.0%). Both EN formula will be fed according to the following protocol: 400 mL/24 h on postoperative day (POD)-1; 800 mL on POD-2; 1200 mL on POD-3 and 1600 mL from POD-4 to POD-8. On POD-9, oral food intake will be initiated. A continuous glucose monitoring (CGM) device will be used to monitor blood glucose levels from POD-1 to -8. The primary outcome is the mean time-in-range (TIR) across the 48 h from POD-1 to -2. TIR is defined as the percentage-time that blood glucose remains within the targeted range of 70-180 mg/dL. The primary analysis will calculate the least squares mean difference in TIR over the 48 h (POD-1 to -2) between the two groups, with p-values calculated to test the null hypothesis that the mean difference between the groups is zero. The secondary outcomes will be as follows: 1) the incidence of PICs and/or other adverse events within 30 days after esophagectomy or during the hospital stay; 2) the number of cases requiring any dose alteration in EN formula during monitoring; 3) the number of cases requiring interventions for hyperglycemia or hypoglycemia; 4) the rates in change of nutritional indicators, such as serum albumin, prealbumin, and total protein levels, during the post-surgical hospital stay (vs. those values on the day of admission); and 5) the following CGM indices in relation to the incidence rate of PICs within 30 days after esophagectomy: the mean values for time-above-range (TAR), area under the curve (AUC), and TIR for each POD or from POD-1 to -8. TAR is defined as the percentage of time of a patient is recorded as having hyperglycemia (>blood glucose level of 180 mg/dL), and is indicative of the frequency and duration of hyperglycemia. AUC, which identifies periods of hyperglycemia and provides a comprehensive picture of glucose variability and control in diabetes management, is defined as the area under the curve over blood glucose level of 180 mg/dL on CGM monitoring. DISCUSSION: This study is the first to investigate the impact of a low-carbohydrate EN formula on hyperglycemic control during perioperative nutritional management of esophageal cancer. These results will help to outline whether glycemic control should be also considered for non-diabetic patients during hospital care. TRIAL REGISTRATION: This trial has been registered in the Japanese Registry of Clinical Trials (jRCTs031240081).
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Dieta Baja en Carbohidratos , Nutrición Enteral , Neoplasias Esofágicas , Hiperglucemia , Complicaciones Posoperatorias , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Glucemia , Dieta Baja en Carbohidratos/métodos , Nutrición Enteral/métodos , Neoplasias Esofágicas/cirugía , Esofagectomía/efectos adversos , Hiperglucemia/etiología , Hiperglucemia/dietoterapia , Hiperglucemia/prevención & control , Complicaciones Posoperatorias/prevención & control , Ensayos Clínicos Controlados Aleatorios como Asunto , Ensayos Clínicos Fase II como AsuntoRESUMEN
Fructose ingestion increases circulating glucagon-like peptide-1 (GLP-1) and insulin, yet the specific contributions of these hormonal responses to glycaemic control remain incompletely defined. We hypothesised that fructose metabolism in intestinal L-cells triggers GLP-1 secretion, which then potentiates insulin secretion and counteracts fructose-induced hyperglycaemia. To test this hypothesis, we systematically characterised metabolic responses across multiple mouse strains after 24 h ad libitum fructose ingestion. In both lean (NSY.B6-a/a) and obese diabetic (NSY.B6-Ay/a) mice, fructose elevated plasma insulin, GLP-1 and glucose-dependent insulinotropic polypeptide (GIP). The insulin response was preserved in GIP receptor-deficient mice (Gipr-/-) but was abolished in proglucagon-deficient mice (Gcg-/-) by pharmacological GLP-1 receptor antagonism, indicating a requirement for GLP-1, but not GIP. Across strains, fructose-induced insulin response correlated with attenuation of post-fructose glycaemia, consistent with insulin being essential for suppressing fructose-induced hyperglycaemia. To explore the mechanism underlying fructose-induced GLP-1 secretion, we combined ATP-sensitive potassium channel-deficient mice (Kcnj11-/-), the GLUTag L-cell line, and metabolic tracing of 13C-labelled fructose in freshly isolated intestinal crypts. These complementary approaches support a model in which fructolysis increases the ATP/ADP ratio in L-cells, closes KATP channels and stimulates GLP-1 secretion. In obese diabetic mice, increased fructolytic flux and a higher ATP/ADP ratio were associated with elevated GLP-1 levels, further corroborating this model. Collectively, our findings indicate that intestinal fructose metabolism drives GLP-1 secretion required to potentiate insulin secretion, thereby establishing a gut-pancreas axis that counter-regulates fructose-induced hyperglycaemia. KEY POINTS: Fructose ingestion acutely increases plasma insulin levels, but the underlying mechanisms and physiological significance remain elusive. Our study demonstrates that short-term (24 h) fructose ingestion in mice elevates both insulin and glucagon-like peptide 1 (GLP-1) levels in the blood, with the plasma insulin response being GLP-1-dependent. We found that fructose metabolism in intestinal L-cells triggered GLP-1 secretion by increasing the ATP/ADP ratio and closing ATP-sensitive K+ (KATP) channels. This intestinal fructose metabolism-GLP-1-ß-cell axis plays a crucial role in preventing fructose-induced hyperglycaemia, an effect that is compromised in obese diabetic mice. These insights highlight the previously unclear metabolic responses following short-term fructose ingestion and their importance in glucose homeostasis.
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Fructosa , Péptido 1 Similar al Glucagón , Hiperglucemia , Células Secretoras de Insulina , Animales , Péptido 1 Similar al Glucagón/metabolismo , Fructosa/metabolismo , Hiperglucemia/metabolismo , Hiperglucemia/inducido químicamente , Hiperglucemia/prevención & control , Ratones , Masculino , Insulina/sangre , Insulina/metabolismo , Ratones Endogámicos C57BL , Polipéptido Inhibidor Gástrico/metabolismo , Ratones Noqueados , Células Secretoras de Insulina/metabolismo , Receptor del Péptido 1 Similar al Glucagón/metabolismo , Receptores de la Hormona Gastrointestinal/genética , Receptores de la Hormona Gastrointestinal/metabolismoRESUMEN
INTRODUCTION: Effective glucose control in surgical patients at risk of hyperglycaemia and hypoglycaemia is crucial, as these conditions can lead to surgical site infections, prolonged hospital stays and death. Fingerstick glucose monitoring (FSGM), the standard measurement of glucose, can be painful for patients and time-consuming for nursing staff, especially with hourly monitoring around surgery. Continuous glucose monitoring systems (CGMS) offer a less invasive alternative with better glucose regulation in outpatients.The GLUCOSENS study compares the effects of CGMS and FSGM on point-of-care measurements and time-in-range (3.9-10.0 mmol/l) glucose levels (primary outcome), patient satisfaction and experience and nursing staff workload and experience in surgical wards. Furthermore, it evaluates CGMS accuracy during perioperative periods and medical imaging. METHODS AND ANALYSIS: This Danish two-centre study will be conducted at the general surgical wards of Odense and Zealand University Hospital and will involve 305 patients over 18 months. The study is divided into three periods: first, a standard care period with point-of-care FSGM (110 patients); second, an intervention period with point-of-care CGMS (110 patients); third, another standard care period with point-of-care FSGM combined with a blinded sensor for comparing continuous glucose data from this period with continuous glucose data from the intervention period (85 patients). Furthermore, the study will include 24 nursing staff.Data will be collected through medical file reviews on glucose levels, patient satisfaction questionnaires, a patient field study, an observation study of the nursing staff's workload and qualitative interviews of nursing staff. ETHICS AND DISSEMINATION: The study is registered with the Records of Processing Activities in the Region of Southern Denmark for research and quality projects (ID number: 23/36734) and has been approved by the Regional Scientific Ethical Committee in Southern Denmark (ID number: S-20240041). The results will be published in international peer-reviewed journals. TRAIL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT06473480).
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Automonitorización de la Glucosa Sanguínea , Glucemia , Hiperglucemia , Hipoglucemia , Humanos , Glucemia/análisis , Automonitorización de la Glucosa Sanguínea/métodos , Automonitorización de la Glucosa Sanguínea/instrumentación , Monitoreo Continuo de Glucosa , Dinamarca , Hiperglucemia/prevención & control , Hiperglucemia/diagnóstico , Hipoglucemia/prevención & control , Monitoreo Fisiológico/métodos , Estudios Multicéntricos como Asunto , Satisfacción del Paciente , Sistemas de Atención de PuntoRESUMEN
INTRODUCTION: Patients with poor perioperative glycaemic control after total joint arthroplasty are at an increased risk of complications, mortality, delayed return to function and increased costs of care. Although correction of hyperglycaemia has been shown to improve patient outcomes, there is a lack of consensus regarding optimal perioperative glucose management after total joint replacement surgery. This pilot study aims to assess the feasibility of performing a multicentre randomised controlled trial to investigate the effect of perioperative metformin use on glycaemic control in the setting of total joint arthroplasty. METHODS AND ANALYSIS: This blinded, placebo-controlled, pilot randomised controlled trial will enrol 40 participants aged 18-99 years undergoing total hip or knee arthroplasty at a single academic tertiary centre. Patients will be randomly allocated to two groups of 20 participants each and will receive metformin or a placebo, respectively, for 2 weeks preoperatively, continued on the day of surgery, and up to 2 days postoperatively. The primary outcome is a composite of four endpoints to assess study feasibility: timely recruitment, timely study drug administration, protocol adherence and retention. Secondary outcomes include perioperative glycaemic variability, sliding scale insulin utilisation, hospital length of stay and 90-day rates of infection, mortality and readmission. Analyses will be on an intention-to-treat basis. ETHICS AND DISSEMINATION: The protocol was approved by Oregon Health & Science University Institutional Review Board, STUDY00025798. Written informed consent will be obtained for study participation. Findings will be disseminated via publication in peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER: NCT06280274.
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Artroplastia de Reemplazo de Cadera , Artroplastia de Reemplazo de Rodilla , Hiperglucemia , Hipoglucemiantes , Metformina , Atención Perioperativa , Complicaciones Posoperatorias , Humanos , Metformina/uso terapéutico , Metformina/administración & dosificación , Proyectos Piloto , Artroplastia de Reemplazo de Cadera/efectos adversos , Hipoglucemiantes/uso terapéutico , Hipoglucemiantes/administración & dosificación , Artroplastia de Reemplazo de Rodilla/efectos adversos , Anciano , Persona de Mediana Edad , Adulto , Femenino , Masculino , Anciano de 80 o más Años , Atención Perioperativa/métodos , Adolescente , Adulto Joven , Ensayos Clínicos Controlados Aleatorios como Asunto , Glucemia , Hiperglucemia/tratamiento farmacológico , Hiperglucemia/prevención & control , Complicaciones Posoperatorias/prevención & control , Control Glucémico/métodosRESUMEN
BACKGROUND: Liver graft function is related to the quality of liver transplantation (LT). High-quality perioperative glycemic management is considered hepatoprotective. However, no studies have explored the effects of specialized and staged blood glucose management target ranges on reducing glycemic variability (GV) and early allograft dysfunction (EAD) after LT. METHODS: In this prospective randomized controlled trial, a total of 188 LT recipients were randomly assigned 1:1 to the less intensive glucose management (LIGM) group and the more intensive glucose management (MIGM) group. They followed goals of 7.8-10.0 mmol/L and 4.5-6.7 mmol/L in the pre-anhepatic and anhepatic phases, respectively, and the goals of 4.1-10.0 mmol/L in the neohepatic phase and postoperatively. The primary outcome was EAD, and the secondary outcomes were GV, incidence of hyperglycemia/hypoglycemia, postoperative liver enzyme levels, 30-day postoperative infection rate, one-year survival rate, and TNF-α, IL-6 and C-reactive protein levels. RESULTS: A total of 182 adult patients (89 in the LIGM group and 93 in the MIGM group) completed the study. The mean age of the recipients was 51.46 ± 10.79 years, and the median MELD score before surgery was 16. The incidence of EAD was significantly lower in the LIGM group than in the MIGM group (10.11 % vs 31.18 %, P < 0.001), with a relative risk (RR) of 0.32 (2-sided 95 % CI 0.110-0.562). There was no statistical difference in the 30-day postoperative infection rate between the two groups (P > 0.05). The one-year survival rate of the LIGM group was higher than that of the MIGM group (92.13 % vs 82.02 %, P = 0.044). CONCLUSIONS: Adopting LIGM (7.8-10.0 mmol/L) during the pre-anhepatic and anhepatic phases helps to reduce the incidence of EAD after LT and promotes the recovery of liver function, but does not increase the incidence of postoperative infections.
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Glucemia , Control Glucémico , Trasplante de Hígado , Atención Perioperativa , Complicaciones Posoperatorias , Disfunción Primaria del Injerto , Humanos , Trasplante de Hígado/efectos adversos , Trasplante de Hígado/métodos , Femenino , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Glucemia/análisis , Glucemia/metabolismo , Adulto , Control Glucémico/métodos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/etiología , Hiperglucemia/prevención & control , Hiperglucemia/epidemiología , Atención Perioperativa/métodos , Hipoglucemia/epidemiología , Hipoglucemia/prevención & control , Hipoglucemiantes/administración & dosificación , Hipoglucemiantes/uso terapéutico , Hígado , Disfunción Primaria del Injerto/epidemiología , Disfunción Primaria del Injerto/prevención & controlRESUMEN
Western diets are a public health concern as excess intake of simple sugars and fatty foods, and consequently low consumption of fruits and vegetables, can contribute to obesity and other chronic diseases such as diabetes mellitus, metabolic syndrome, cardiovascular diseases, and cancer. Due to the high prevalence of diseases related to Western diets, the objective of this study was to evaluate whether the inclusion of a novel fiber-rich complex could prevent high fat diet-induced weight gain, adiposity, hyperglycemia, dyslipidemia, and oxidative stress in young male Sprague-Dawley rats, Rattus norvegicus. The novel fiber complex contained a blend of bioactive ingredients: 27% flaxseed, 15.9% wheat bran, 14.8% wheat germ, 10% psyllium, 13.1% brewer's yeast, and 19.2% grapeseed flour. The study included 24 6-week-old rats divided into three groups that were fed either a control diet (C; standard rodent maintenance diet) containing fiber (3.8%g diet); high-fat diet (H) containing Solka Floc cellulose fiber (6.46%g diet); or high-fat diet in which 5% of the diet was replaced with the novel fiber complex (HF) (total fiber: 5%g fiber complex + 6.14%g Solka Floc). Rats in all diet groups gained significant weight during the 6-week feeding period (p < 0.001) consistent with normal growth. Whereas no differences were observed for blood lipids or beta-hydroxybutyrate, consumption of the H diet significantly increased adiposity (p < 0.001), liver triglycerides (p < 0.001), and fasting whole blood glucose concentrations (p < 0.001) in comparison to the C diet. These effects of high fat consumption were not prevented by the inclusion of the novel fiber complex in this experimental design.
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Dieta Alta en Grasa , Fibras de la Dieta , Animales , Fibras de la Dieta/administración & dosificación , Fibras de la Dieta/farmacología , Masculino , Ratas Sprague-Dawley , Dieta Alta en Grasa/efectos adversos , Ratas , Adiposidad/efectos de los fármacos , Estrés Oxidativo/efectos de los fármacos , Aumento de Peso/efectos de los fármacos , Glucemia , Dislipidemias/prevención & control , Hiperglucemia/prevención & control , Obesidad/prevención & controlRESUMEN
Certain polyphenols improve glucose tolerance by stimulating glucagon-like peptide-1 (GLP-1) secretion from intestinal L-cells. Ashitaba chalcones, 4-hydroxyderricin (4-HD), and xanthoangelol (XAG) have antihyperglycemic effects, but their molecular mechanism, including whether they promote GLP-1 secretion is unknown. This study investigates the 4-HD-induced GLP-1 secretory mechanisms and its anti-hyperglycemic effects. The secretory mechanisms were examined in STC-1 cells and antihyperglycemic effects in male ICR mice. In STC-1 cells, 4-HD, but not XAG, stimulated GLP-1 secretion through membrane depolarization and intracellular Ca2+ increase [Ca2+]i, via the L-type Ca2+ channel (VGCC). Verapamil and nifedipine, blockers of VGCC, and treatment in Ca2+-free buffer abolished 4-HD effects on [Ca2+]i and GLP-1 secretion. Moreover, 4-HD activated CaMKII and ERK1/2. Consistently, oral 4-HD suppressed postprandial hyperglycemia in mice and increased plasma GLP-1 and insulin levels, GLUT4 translocation, and activation of LKB-1 and Akt pathways in skeletal muscle. Furthermore, exendin 9-39, a GLP-1R antagonist, and compound C, an AMPK inhibitor, completely canceled the 4-HD-caused anti-hyperglycemic activities. 4-HD stimulated GLP-1 secretion through membrane depolarization coupled with [Ca2+]i increase via VGCC in L-cells and activated AMPK- and insulin-induced GLUT4 translocation in skeletal muscle. Thus, 4-HD possesses dual mechanisms for the prevention of hyperglycemia.
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Chalconas , Péptido 1 Similar al Glucagón , Hiperglucemia , Animales , Péptido 1 Similar al Glucagón/metabolismo , Masculino , Ratones Endogámicos ICR , Hiperglucemia/prevención & control , Hipoglucemiantes/farmacología , Chalconas/farmacología , Ratones , Periodo Posprandial , Línea Celular , Chalcona/farmacología , Chalcona/análogos & derivados , Canales de Calcio Tipo L/metabolismo , Calcio/metabolismo , Proteína Quinasa Tipo 2 Dependiente de Calcio Calmodulina/metabolismo , Transportador de Glucosa de Tipo 4/metabolismo , GlucemiaRESUMEN
OBJECTIVE: Hyperglycemia, or glucose values >180 mg/dL, is associated with adverse post-operative outcomes. Our objective was to determine the impact of improving peri-operative glycemic control and evaluate infectious complications among patients with type 2 diabetes mellitus undergoing open gynecologic surgery. METHODS: A multidisciplinary team standardized pre-operative screening, referral algorithms, and intra-operative and post-operative hyperglycemia management (Surgical Universal euGlycemic Attainment during Recovery initiative). We compared outcomes between a baseline cohort (March 2016-December 2017) and an intervention cohort (February 2018-August 2022). Patients with type 1 diabetes, and planned minimally invasive, multi-team, or emergency surgery were excluded. Clinical and demographic characteristics were compared using the χ2 test, Fisher exact test, t test, or Wilcoxon rank-sum test, and generalized linear mixed models were used with a logit link function. All statistical analyses were performed using Stata/MP v17.0 (College Station, StataCorp). RESULTS: We assessed 103 baseline patients and 167 intervention patients with diabetes. In the baseline cohort, 26 patients (25%) had hemoglobin A1C screened prior to surgery compared with 158 (95%) in the intervention cohort (p < .001). All surgical patients were screened for diabetes to determine eligibility, and we tracked the rate of patients newly diagnosed with type 2 diabetes (18 patients or 11%). The percentages of glucose values ≤180 mg/dL pre-operatively or intra-operatively were similar between cohorts, but the intervention cohort had increased compliance with assessing glucose intra-operatively (84% compared with 55%, p < .001). The percentage of post-operative glucose values ≤180 mg/dL increased from 77% in the baseline cohort to 86% in the intervention cohort (p = .002). The average post-operative glucose value was 10 mg/dL lower in the intervention cohort than in the baseline cohort (p = .005). Rates of surgical site infection, pneumonia, and urinary tract infection were similar between cohorts. CONCLUSION: Our initiative improved compliance with pre-operative glycemic screening and decreased hyperglycemia among diabetic patients. We did not identify the correlation between glycemic control and infectious complications.
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Diabetes Mellitus Tipo 2 , Control Glucémico , Procedimientos Quirúrgicos Ginecológicos , Complicaciones Posoperatorias , Humanos , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/complicaciones , Femenino , Control Glucémico/métodos , Persona de Mediana Edad , Anciano , Adulto , Complicaciones Posoperatorias/prevención & control , Procedimientos Quirúrgicos Ginecológicos/efectos adversos , Glucemia/análisis , Hiperglucemia/prevención & control , Estudios de CohortesRESUMEN
PURPOSE: High-pressure-processed (HPP) rice is white rice that maintains some key functional food ingredients of brown rice, such as polyphenols. We examined whether HPP rice intake during interval walking training (IWT) improved glycemic control with enhanced methylation of the NFKB2 gene in hyperglycemic older subjects. METHODS: We recruited 51 people aged ~ 70 yr who had already performed IWT for ≥ 6 months, but had hyperglycemia (blood glucose concentration ([Glc]) > 110 mg/dl or HbA1c > 6.0% while fasting). Participants were randomly divided into control (CNT) or HPP rice (HPR) groups and instructed to perform IWT for an additional 4 months while ingesting 75 g dry weight of either white rice or HPP rice, respectively, at every breakfast and dinner. Before and after intervention, [Glc] was measured by continuous glucose monitoring for 5 days, with standardized breakfast on day 5. Methylation of NFKB2 was measured by pyrosequencing. RESULTS: After intervention, mean fasting [Glc] values for 180 min before breakfast over 4 days (days 2-5) marginally decreased in HPR but were not different from CNT (P = 0.17). However, the standard deviation during the period decreased more in HPR than in CNT (P = 0.013). Moreover, total area under the curve (tAUC) for 180 min after breakfast on day 5 decreased more in HPR than in CNT (P = 0.035). The change in tAUC on day 5 after the intervention was negatively correlated with that in NFKB2 gene methylation (P = 0.002). CONCLUSION: HPP rice intake during IWT improved glycemic control with suppressed reduction in NFKB2 gene methylation in hyperglycemic older people. TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION: UMIN000024390; October 13, 2016.
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Glucemia , Metilación de ADN , Control Glucémico , Hiperglucemia , Oryza , Caminata , Humanos , Anciano , Masculino , Femenino , Hiperglucemia/prevención & control , Control Glucémico/métodos , Caminata/fisiología , Glucemia/metabolismo , Subunidad p52 de NF-kappa B/genética , Subunidad p52 de NF-kappa B/metabolismoRESUMEN
BACKGROUND: Surgery induces a stress response, causing insulin resistance that may result in postoperative hyperglycemia, which is associated with increased incidence of complications, longer hospitalization, and greater mortality. OBJECTIVE: This study examined the effect of metformin treatment on the percentage of patients experiencing postoperative hyperglycemia after elective colon cancer surgery. DESIGN: This was a randomized, double-blind, placebo-controlled trial. SETTINGS: The study was conducted at Slagelse Hospital in Slagelse, Denmark. PATIENTS: Patients without diabetes planned for elective surgery for colon cancer were included. INTERVENTIONS: Patients received metformin (500 mg 3× per day) or placebo for 20 days before and 10 days after surgery. MAIN OUTCOME MEASURES: Blood glucose levels were measured several times daily until the end of postoperative day 2. The main outcome measures were the percentage of patients who experienced at least 1 blood glucose measurement >7.7 and 10 mmol/L, respectively. Rates of complications within 30 days of surgery and Quality of Recovery-15 scores were also recorded. RESULTS: Of the 48 included patients, 21 patients (84.0%) in the placebo group and 18 patients (78.3%) in the metformin group had at least 1 blood glucose measurement >7.7 mmol/L ( p = 0.72), and 13 patients (52.0%) in the placebo group had a measurement >10.0 mmol/L versus 5 patients (21.7%) in the metformin group ( p = 0.04). No differences in complication rates or Quality of Recovery-15 scores were seen. LIMITATIONS: The number of patients in the study was too low to detect a possible difference in postoperative complications. Blood glucose was measured as spot measurements instead of continuous surveillance. CONCLUSIONS: In patients without diabetes, metformin significantly reduced the percentage of patients experiencing postoperative hyperglycemia, as defined as spot blood glucose measurements >10 mmol/L after elective colon cancer surgery. See Video Abstract . TRATAMIENTO PERIOPERATORIO CON METFORMINA PARA REDUCIR LA HIPERGLUCEMIA POSOPERATORIA DESPUS DE LA CIRUGA DE CNCER DE COLON ENSAYO CLNICO ALEATORIZADO: ANTECEDENTES:La cirugía induce una respuesta de estrés que causa resistencia a la insulina que puede resultar en hiperglucemia posoperatoria. La hiperglucemia posoperatoria se asocia con una mayor incidencia de complicaciones, una hospitalización más prolongada y una mayor mortalidad.OBJETIVO:Este estudio examinó el efecto del tratamiento con metformina en el porcentaje de pacientes que experimentaron hiperglucemia posoperatoria después de una cirugía electiva de cáncer de colon.DISEÑO:Este fue un ensayo aleatorio, doble ciego y controlado con placebo.AJUSTES:El estudio se realizó en el Hospital Slagelse, Slagelse, Dinamarca.PACIENTES:Se incluyeron pacientes sin diabetes planificados para cirugía electiva por cáncer de colon.INTERVENCIONES:Los pacientes recibieron 500 mg de metformina tres veces al día o placebo durante 20 días antes y 10 días después de la cirugía.PRINCIPALES MEDIDAS DE RESULTADO:Los niveles de glucosa en sangre se midieron varias veces al día hasta el final del segundo día postoperatorio. Las principales medidas de resultado fueron el porcentaje de pacientes que experimentaron al menos una medición de glucosa en sangre por encima de 7,7 y 10 mmol/l, respectivamente. También se registraron las tasas de complicaciones dentro de los 30 días posteriores a la cirugía y las puntuaciones de Calidad de recuperación-15.RESULTADOS:De los 48 pacientes incluidos, 21 (84,0%) en el grupo placebo y 18 (78,3%) en el grupo metformina tuvieron al menos una medición de glucosa en sangre superior a 7,7 mmol/l (p = 0,72), y 13 (52,0%) los pacientes del grupo de placebo tuvieron una medición superior a 10,0 mmol/l frente a 5 (21,7%) en el grupo de metformina (p = 0,04). No se observaron diferencias en las tasas de complicaciones ni en las puntuaciones de Calidad de recuperación-15.LIMITACIONES:El número de pacientes en el estudio fue demasiado bajo para detectar una posible diferencia en las complicaciones posoperatorias. La glucosa en sangre se midió mediante mediciones puntuales en lugar de vigilancia continua.CONCLUSIONES:En pacientes sin diabetes, la metformina redujo significativamente el porcentaje de pacientes que experimentaron hiperglucemia postoperatoria, definida como mediciones puntuales de glucosa en sangre por encima de 10 mmol/l después de una cirugía electiva de cáncer de colon . (Traducción-Dr Yolanda Colorado ).
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Glucemia , Neoplasias del Colon , Hiperglucemia , Hipoglucemiantes , Metformina , Complicaciones Posoperatorias , Humanos , Metformina/uso terapéutico , Masculino , Femenino , Hiperglucemia/prevención & control , Hiperglucemia/epidemiología , Hiperglucemia/etiología , Neoplasias del Colon/cirugía , Anciano , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/epidemiología , Hipoglucemiantes/uso terapéutico , Método Doble Ciego , Persona de Mediana Edad , Glucemia/metabolismo , Glucemia/análisis , Atención Perioperativa/métodos , Procedimientos Quirúrgicos Electivos/efectos adversos , Colectomía/efectos adversos , Dinamarca/epidemiologíaRESUMEN
PURPOSE OF REVIEW: Perioperative outpatient (ambulatory) care of the adult patient with diabetes requires unique considerations that vary from the inpatient setting. This review highlights specific pre, intra, and postoperative care steps for patients with diabetes undergoing ambulatory surgery, summarizing recent clinical trials, expert reviews, and emerging evidence. RECENT FINDINGS: There is a paucity of evidence examining optimal diabetes management in the outpatient setting. Currently, there are limited studies regarding preoperative management of oral hypoglycemic agents, home insulin, and carbohydrate-containing beverages. SUMMARY: Future research needs to specifically examine chronic blood glucose control, day of surgery targets, effective home medication management and the risk of perioperative hyperglycemia in ambulatory surgery. Education, protocols and resources to support the care of perioperative patients in the outpatient setting will aid providers on the day of surgery and provide optimal diabetes care leading up to surgery.
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Procedimientos Quirúrgicos Ambulatorios , Diabetes Mellitus , Hipoglucemiantes , Atención Perioperativa , Humanos , Procedimientos Quirúrgicos Ambulatorios/efectos adversos , Procedimientos Quirúrgicos Ambulatorios/normas , Hipoglucemiantes/uso terapéutico , Hipoglucemiantes/administración & dosificación , Hipoglucemiantes/efectos adversos , Atención Perioperativa/métodos , Atención Perioperativa/normas , Glucemia/efectos de los fármacos , Glucemia/análisis , Insulina/uso terapéutico , Insulina/administración & dosificación , Atención Ambulatoria/normas , Atención Ambulatoria/métodos , Cuidados Posoperatorios/normas , Cuidados Posoperatorios/métodos , Guías de Práctica Clínica como Asunto , Hiperglucemia/prevención & control , Hiperglucemia/etiología , Cuidados Preoperatorios/métodos , Cuidados Preoperatorios/normasRESUMEN
Patients with hyperglycemia, thyroid dysfunction, and adrenal insufficiency face increased perioperative risk, which may be mitigated by appropriate management. This review addresses preoperative glycemic control, makes evidence-based recommendations for the increasingly complex perioperative management of noninsulin diabetes medications, and provides guideline-supported strategies for the perioperative management of insulin, including suggested indications for continuous intravenous insulin. The authors propose a strategy for determining when surgery should be delayed in patients with thyroid dysfunction and present a matrix for managing perioperative stress dose corticosteroids based on the limited evidence available.
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Insuficiencia Suprarrenal , Atención Perioperativa , Humanos , Insuficiencia Suprarrenal/diagnóstico , Atención Perioperativa/métodos , Atención Perioperativa/normas , Insulina/uso terapéutico , Insulina/administración & dosificación , Diabetes Mellitus/tratamiento farmacológico , Enfermedades de la Tiroides/cirugía , Hipoglucemiantes/uso terapéutico , Hiperglucemia/prevención & control , Hiperglucemia/tratamiento farmacológicoRESUMEN
BACKGROUND: Dexamethasone is associated with increased blood glucose levels that could impact patient outcomes or management. This study aimed to synthesize the available evidence regarding the impact of an intraoperative single dose of dexamethasone on blood glucose levels. METHODS: We searched CENTRAL, MEDLINE, and clinicaltrials.gov for randomized controlled trials (RCTs) comparing a single intraoperative dose of dexamethasone to control in adult patients who underwent noncardiac surgery. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the review was registered in PROSPERO (CRD42023420562). Data were pooled using a random-effects model. We reported pooled dichotomous data using odds ratios (OR) and continuous data using the mean difference (MD), reporting 95% confidence intervals (95% CIs), and corresponding P-values for both. Confidence in the evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. As primary outcomes we assessed maximum blood glucose levels measurement and variation from baseline within 24 hours of surgery; blood glucose levels measurement and variation from baseline at 2, 4, 8, 12, and 24 hours after dexamethasone administration. As secondary outcomes, we evaluated insulin requirements and hyperglycemic events. RESULTS: We included 23 RCTs, enrolling 11,154 participants overall. Dexamethasone was associated with a significant increment in blood glucose levels compared to control at all timepoints. The results showed an increase compared to control of 0.37 mmol L-1 (6.7 mg dL-1) at 2 hours (95% CI, 0.16-0.58 mmol L-1 or 2.9-10.5 mg dL-1), 0.97 mmol L-1 (17.5 mg dL-1) at 4 hours (95% CI, 0.67-1.25 mmol L-1 or 12.1-22.5 mg dL-1), 0.96 mmol L-1 (17.3 mg dL-1) at 8 hours (95% CI, 0.55-1.36 mmol L-1 or 9.9-24.5 mg dL-1), 0.90 mmol L-1 (16.2 mg dL-1) at 12 hours (95% CI, 0.62-1.19 mmol L-1 or 11.2-21.4 mg dL-1) and 0.59 mmol L-1 (10.6 mg dL-1) at 24 hours (95% CI, 0.22-0.96 mmol L-1 or 4.0-17.3 mg dL-1). No difference was found between subgroups regarding diabetic status (patients with diabetes versus patients without diabetes) in all the outcomes except 2 (maximum blood glucose levels variation within 24 hours and variation at 4 hours) and dexamethasone dose (4-5 mg vs 8-10 mg) in all the outcomes except 2 (blood glucose levels at 24 hours and hyperglycemic events). CONCLUSIONS: Mean blood glucose levels rise between 0.37 and 1.63 mmol L-1 (6.7 and 29.4 mg dL-1) within 24 hours after a single dose of dexamethasone administered at induction of anesthesia compared to control, but in most patients this difference will not be clinically relevant.
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Glucemia , Dexametasona , Cuidados Intraoperatorios , Humanos , Biomarcadores/sangre , Glucemia/efectos de los fármacos , Glucemia/metabolismo , Dexametasona/administración & dosificación , Dexametasona/efectos adversos , Hiperglucemia/sangre , Hiperglucemia/prevención & control , Insulina/sangre , Cuidados Intraoperatorios/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del TratamientoRESUMEN
The percentage of obese people is increasing worldwide, causing versatile health problems. Obesity is connected to diseases such as diabetes and cardiovascular diseases, which are preceded by a state called metabolic syndrome. Diets rich in fruits and vegetables have been reported to decrease the risk of metabolic syndrome and type 2 diabetes. Berries with a high polyphenol content, including lingonberry (Vaccinium vitis-idaea L.), have also been of interest to possibly prevent obesity-induced metabolic disturbances. In the present study, we prepared an extract from the by-product of a lingonberry juice production process (press cake/pomace) and investigated its metabolic effects in the high-fat diet-induced model of obesity in mice. The lingonberry skin extract partly prevented weight and epididymal fat gain as well as a rise in fasting glucose level in high-fat diet-fed mice. The extract also attenuated high-fat diet-induced glucose intolerance as measured by an intraperitoneal glucose tolerance test (IPGTT). The extract had no effect on the levels of cholesterol, triglyceride or the adipokines adiponectin, leptin, or resistin. The results extend previous data on the beneficial metabolic effects of lingonberry. Further research is needed to explore the mechanisms behind these effects and to develop further health-promoting lingonberry applications.