ABSTRACT
BACKGROUND: Preoperative carbohydrate loading is a recommended component of enhanced recovery protocols (ERP's), however the impact on postoperative stress-induced insulin resistance remains poorly studied in both diabetics and non-diabetics. METHODS: Using our ERP, a preoperative grape juice group (Grape) was compared to the use of 25â¯g maltodextrin/3â¯g citrulline (G.E.D.™, SOF Health, LLC) for carbohydrate loading. RESULTS: The population included 171 patients (Grape nâ¯=â¯96; GED nâ¯=â¯75). Glycemic variability was significantly worse for the Grape group on POD 0 in both non-diabetic (70% vs 41%; pâ¯<â¯0.05) and diabetic patients (66% vs 34%; pâ¯<â¯0.05). Significantly more Grape patients required postoperative insulin regardless of diabetic status. CONCLUSION: Following bariatric surgery, the impact of stress induced hyperglycemia is primarily on POD 0 in non-diabetics whereas the effect extends into POD 1 for diabetics. Preoperative loading with G.E.D.™ versus grape juice is associated with a significantly lower rate of glycemic variation and postoperative insulin requirement, demonstrating that drink composition and treatment process reduces the severity of postoperative stress induced hyperglycemia in bariatric surgery patients.