Highlights
- •Artificial pancreas facilitates strict glycemic control after pancreatic surgery.
- •Tight glycemic control reduces infectious complications in patients with diabetes.
- •Postoperative glycemic variability is important in perioperative glycemic control.
- •Adipose tissue inflammation is associated with postoperative infectious complication. .
Abstract
Background
We sought to investigate the efficacy of perioperative tight glycemic control (TGC)
in reducing of postoperative infectious complications (POICs) and study its impact
on early inflammatory mediators in patients who underwent pancreaticoduodenectomy.
Methods
In this non-randomized trial, the artificial pancreas (AP) group received TGC (target
glucose range of 80–110 mg/dL; n = 14), while the control group received conventional
glycemic control (range of 80–180 mg/dL; n = 15). The primary endpoint was POICs.
Results
The AP group had a markedly decreased POIC rate (28.6% vs. 73.3%; P = 0.027), mean glycemic variability (13.5 ± 3.5% vs. 16.4 ± 5.9%; P = 0.038), and plasma interleukin-6 level (26.3 ± 33.8 vs 98.3 ± 89.1 pg/ml; P = 0.036) compared to the control group, but insulin dosage (27.0 ± 13.4 vs. 10.2 ± 16.2 U; P = 0.002) and the adiponectin ratio (i.e., postoperative/preoperative adiponectin;
0.8 ± 0.2 vs. 0.6 ± 0.3; P = 0.021) were markedly higher in the AP group.
Conclusions
Among patients undergoing PD with impaired glucose tolerance, AP facilitated strict
glycemic control and resulted in a reduction of anti-inflammatory mediators and POICs.
Summary
Perioperative hyperglycemia increases postoperative infectious complications; however,
tight glycemic control using artificial pancreas can reduce them via a dual effect.
Artificial pancreas facilitates strict and safe glycemic control while reducing anti-inflammatory
mediators, including adiponectin, following pancreaticoduodenectomy.
Keywords
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Article info
Publication history
Published online: December 05, 2019
Accepted:
December 3,
2019
Received in revised form:
November 25,
2019
Received:
September 9,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
