We examined whether perioperative intensive insulin therapy (IIT) using an artificial pancreas (AP) with a closed-loop glycemic control system can be used to prevent hypoglycemia in surgical patients.
Between 2006 and 2012, perioperative glycemic control using an AP was performed in 427 patients undergoing general surgery. A total of 305 patients undergoing IIT using an AP in the target blood glucose range of 80 to 110 mg/dL were enrolled in the study. Data were collected prospectively and were reviewed or analyzed retrospectively.
No patients had hypoglycemia. Perioperative mean blood glucose level and achievement rates in target blood glucose range of 80 to 110 mg/dL were 100.5 ± 11.9 mg/dL and 88.1% ± 16.0%, respectively. For the 3 primary operative methods, including hepatic, pancreatic, and esophageal resections, there were no significant differences in glycemic control stability between the types of surgery.
Perioperative IIT using an AP with a closed-loop glycemic control system can be used to prevent hypoglycemia and maintain stable glycemic control with less variability of blood glucose concentration.
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- Stress-induced hyperglycemia.Crit Care Clin. 2001; 17: 107-124
- Glucose control and mortality in critically ill patients.JAMA. 2003; 290: 2041-2047
- Influence of individual characteristics on outcome of glycemic control in intensive care unit patients with or without diabetes mellitus.Mayo Clin Proc. 2005; 80: 1558-1567
- Correlation between hyperglycemia and mortality in a medical and surgical intensive care unit.Minerva Anesthesiol. 2005; 71: 717-725
- Early postoperative hyperglycemia is associated with postoperative complications after pancreatodudenectomy.Ann Surg. 2011; 253: 739-744
- Relationship of perioperative hyperglycemia and postoperative infections in patients who undergo general and vascular surgery.Ann Surg. 2008; 248: 585-591
- Poor postoperative blood glucose control increases surgical site infections after surgery for hepato-biliary-pancreatic cancer: a prospective study in a high-volume institute in Japan.J Hosp Infect. 2008; 68: 230-233
- Glucose potassium insulin infusions in the treatment of acute stroke patients with mild to moderate hyperglycemia: the glucose insulin in stroke trial (GIST).Stroke. 1999; 30: 793-799
- Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures.Ann Thorac Surg. 1999; 67 (discussion, 360–2): 352-360
- Intensive insulin therapy in critically ill patients.N Engl J Med. 2001; 345: 1359-1367
- Intensive insulin therapy in medical ICU.N Engl J Med. 2006; 354: 449-461
- Benefits and risks of tight glucose control in critically ill adults: a meta-analysis.JAMA. 2008; 300: 933-944
- Severe hypoglycemia in critically ill patients: risk factors and outcomes.Crit Care Med. 2007; 35: 2262-2267
- Intensive versus conventional glucose control in critically ill patients.N Engl J Med. 2009; 360: 1283-1297
- Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data.CMAJ. 2009; 180: 821-827
- Intensive insulin therapy in hospitalized patients: a systematic review.Ann Intern Med. 2011; 154: 268-282
- Glycemic control in non-critically ill hospitalized patients: a systematic review and meta-analysis.J Clin Endocrinol Metab. 2012; 97: 49-58
- Insulin therapy in the intensive care unit should be targeted to maintain blood glucose between 4.4 mmol/l and 6.1 mmol/l.Diabetologia. 2008; 51: 911-915
- Artificial endocrine pancreas.J Am Coll Surg. 2001; 193: 310-322
- Pancreatic polypeptide administration reduces insulin requirements of artificial pancreas in pancreatectomized dogs.Artif Organs. 2005; 29: 83-87
- Tight perioperative glycemic control using an artificial endocrine pancreas.Surg Today. 2010; 40: 1-7
- Progressive artificial endocrine pancreas: the era of novel perioperative blood glucose control for surgery.Surg Today. 2011; 41: 1344-1351
- The accuracy of continuous blood glucose monitor during surgery.Anesth Analg. 2008; 106: 160-163
- Accuracy and reliability of continuous blood glucose monitor in post-surgical patients.Acta Anaesthesiol Scand. 2009; 53: 66-71
- The evaluation of the ability of closed-loop glycemic control device to maintain the blood glucose concentration in intensive unit patients.Crit Care Med. 2011; 39: 575-578
- A biometric study of human basal metabolism.Proc Natl Acad Sci USA. 1918; 4: 370-373
- Defining and reporting hypoglycemia in diabetes: a report from the American Diabetes Association Workgroup on Hypoglycemia.Diabetes Care. 2005; 28: 1245-1249
- Hyperglycemia and perioperative glucose management.Curr Pharm Des. 2012; 18: 6195-6203
- Variability of blood glucose concentration and short-term mortality in critically ill patients.Anesthesiology. 2006; 105: 244-252
- Glucose variability is associated with intensive care unit mortality.Crit Care Med. 2010; 38: 838-842
- Intensive insulin therapy and pentastarch resuscitation in severe sepsis.N Engl J Med. 2008; 358: 125-139
- A prospective randomized multi-centre controlled trial on tight glucose control by intensive insulin therapy in adult intensive care units: the Glucocontrol study.Intensive Care Med. 2009; 35: 1738-1748
- Pancreatogenic diabetes after pancreatic resection.Pancreatology. 2011; 11: 268-276
- Perioperative intensive insulin therapy using artificial endocrine pancreas in patients undergoing pancreatectomy.World J Gastroenterol. 2009; 15: 4111-4115
- Continuous postoperative blood glucose monitoring and control by artificial pancreas in patients having pancreatic resection: a prospective randomized clinical trial.Arch Surg. 2009; 144: 933-937
- Effect of intensive insulin therapy using a closed loop glycemic control system in hepatic resection patients: a prospective randomized clinical trial.Diabetes Care. 2009; 32: 1425-1427
- Randomized clinical trial of the effects of immediate enteral nutrition on metabolic responses to major colorectal surgery in an enhanced recovery protocol.Br J Surg. 2004; 91: 1138-1145
- Evidence-based surgical care and the evolution of fast-track surgery.Ann Surg. 2008; 248: 189-198
- Blood glucose control using an artificial pancreas reduces the workload of ICU nurses.J Artif Organs. 2012; 15: 71-76
- Postoperative hyperglycemia and surgical site infection in general surgery patients.Arch Surg. 2010; 145: 858-864
Published online: January 06, 2014
Received in revised form: June 25, 2013
Received: January 10, 2013
Supported by the Japan Ministry of Education, Culture, Sports, Science, and Technology, The Kochi University President's Discretionary Grant, and grant from Nikkiso Co., Ltd.
The authors declare no conflicts of interest.
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.