Simple Versus Complex Preoperative Carbohydrate Drink to Preserve Perioperative Insulin Sensitivity in Laparoscopic Colectomy: A Randomized Controlled Trial.

Abstract

Administration of a preoperative containing complex carbohydrate (CHO) preserves insulin sensitivity after traditional colorectal surgery compared with water or fasting; however, its benefits compared with simple CHO drinks have not been investigated. This randomized controlled trial estimated the extent to which a preoperative simple CHO drink preserves insulin sensitivity, compared with a complex CHO drink. This randomized trial involved 30 nondiabetic adult patients undergoing laparoscopic colon resection. Perioperative care followed an established Enhanced Recovery Pathway (ERP). Patients were randomized 1:1 to receive either a simple CHO drink (400 mL containing 50 gr of fructose) or a complex CHO drink (400 mL containing 40 gr of maltodextrin and 10 gr of fructose) 2 hours before surgery. The primary outcome was intraoperative insulin sensitivity assessed by peripheral glucose uptake (M value) during hyperinsulinemic euglycemic clamp. Secondary outcomes included postoperative hepatic insulin resistance assessed by Homeostatic model assessment (HOMA2-IR), fasting blood glucose (FBG), and C-reactive protein (CRP) at baseline and postoperative day (POD 1-3), 30-day complications, and hospital length of stay (LOS). Intraoperative insulin sensitivity was maintained in both groups with no difference after ingestion of the simple or complex CHO drink [mean (SD) M value 8.3 (3.3) vs 8.8 (3.8) mg/kg/min, P = 0.7). Postoperative insulin sensitivity was maintained, with no differences in hepatic insulin resistance (HOMA2-IR) or fasting blood glucose on POD 1 to 3. There were no differences in complications or LOS. After laparoscopic colectomy in an ERP, perioperative insulin sensitivity was maintained and not further impacted by the preoperative ingestion of a complex or simple CHO drink.