Intensive Versus Conventional Insulin Therapy in Type 2 Diabetes Patients Undergoing D2 Gastrectomy for Gastric Cancer: a Randomized Controlled Trial

Overview

Journal World J Surg

Publisher Wiley

Specialty General Surgery

Date 2010 Sep 30

PMID 20878324

Citations 12

Authors

Shou-Gen Cao

Jian-An Ren

Bo Shen

Dong Chen

Yan-Bing Zhou

Jie-Shou Li

Affiliations

Soon will be listed here.

Abstract

Background: This study was to compare the effect of intensive insulin therapy (IIT) to conventional insulin therapy (CIT) on postoperative outcomes among type 2 diabetes mellitus (DM) patients who underwent D2 gastrectomy for gastric cancer.

Methods: We randomly assigned gastric cancer patients with type 2 DM who underwent radical gastrectomy to receive IIT (maintenance of blood glucose at a level between 4.4 and 6.1 mmol/l) with insulin infusion or CIT (maintenance of blood glucose at a level between 10 and 11.1 mmol/l) during the postoperative period.

Results: Of the 179 eligible patients, 92 patients were assigned to receive IIT and 87 patients to receive CIT. Mean blood glucose concentrations were lower in the intensive group (IG) than in the conventional group (CG) (5.5 ± 0.8 vs. 9.9 ± 1.0 mmol/l, P < 0.001). Hypoglycemia occurred in 6 patients (6.5%) in the IG (P = 0.029) versus in 1 patient (1.1%) in the CG. Hospital mortality did not differ significantly between two groups (4.3% vs. 5.7%, P = 0.742). However, IIT significantly reduced morbidity (from 18.4 to 7.6%, P = 0.031). Also, IIT shortened the days to suture removal, postoperative hospital stay, and postoperative duration of antibiotic use. The HOMA-IR score was lower at all time points in IG. Moreover, IIT increased the postoperative HLA-DR expression on monocytes on postoperative days 3 and 5.

Conclusions: IIT significantly reduced short-term morbidity but not mortality among type 2 DM patients who underwent D2 gastrectomy for gastric cancer. Furthermore, a possible mechanism of suppression of the insulin resistance and improvement of HLA-DR expression may partially explain the benefits of IIT.

Citing Articles

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Glycemic Control Regimens in the Prevention of Surgical Site Infections: A Meta-Analysis of Randomized Clinical Trials.

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Yao R, Ren C, Wu G, Zhu Y, Xia Z, Yao Y Int J Biol Sci. 2020; 16(9):1658-1675.

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Intensive glucose control for critically ill patients: an updated meta-analysis.

Fu Y, Sun Y, Zhang J, Cheng Y Endocr Connect. 2018; 7(12):1288-1298.

PMID: 30352416 PMC: 6240146. DOI: 10.1530/EC-18-0393.

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