Moderate hyperglycemia and a blunted anabolic response to perioperative parenteral amino acids in type 2 diabetes mellitus patients undergoing colorectal cancer surgery

Abstract

Insulin resistance of type 2 diabetes mellitus (T2DM) is accentuated by surgical stress. Hyperglycemia can also be exacerbated by nutrition support; so a balance of anabolic and euglycemic strategies is essential. Patients with T2DM (n=7) or without (ND, n=11) undergoing colorectal cancer surgery received parenteral nutrition (PN) based on 20% of resting energy expenditure as amino acids (AAs, from 20h preop). Glucose, protein kinetics and fractional synthesis rate (FSR) of hepatic secretory proteins were measured with D‐[6,6‐2H2] glucose, L‐[1‐13C]leucine and L‐[ring‐2H5]phenylalanine while fasting preop, and again while receiving PN two days postop. In fasted state preop, subjects were in negative leucine balance, with T2DM being more negative than ND (p<0.027). PN improved leucine balance (p=0.008), but balance was more negative in T2DM. Surgery invoked an acute phase response with increased fibrinogen (p<0.0001) and its FSR (p<0.0007). Albumin FSR was maintained to a similar extent postop. Plasma glucose was similar preop, but higher postop in T2DM (p<0.005), possibly resulting from a tendency for higher endogenous production (p<0.10) and lower clearance (p<0.13). Plasma AAs showed changes typical of surgery attenuated increases in branched chains (p=0.035) and essentials (p=0.026) in T2DM. PN with AAs supports acute phase response in T2DM but with moderate hyperglycemia and a blunted anabolic response. Higher AA doses or combined AA and low glucose are suggested achieve anabolic response in T2DM.(Canadian Institutes of Health Research)