Effect of Preoperative Carbohydrate Loading on Postoperative Recovery of Individuals Who Have Type 2 Diabetes After Total Knee Arthroplasty: A Randomized Controlled Trial
Abstract
BACKGROUND
Many individuals undergoing surgery involving general anesthesia are asked to fast for a prolonged period to ensure perioperative safety, yet this can initiate stress reactions and insulin resistance, harming postoperative recovery. Such fasting may be particularly problematic for those who have type 2 diabetes. Here we assessed how giving such individuals oral carbohydrates before total knee arthroplasty can affect outcomes.
METHODS
We randomized 90 patients who had non-insulin dependent type 2 diabetes mellitus who were scheduled for elective total knee arthroplasty at one medical center between April 2022 and January 2023 to receive oral carbohydrates at 2 or 4 hours before surgery or to receive a carbohydrate-free "placebo" drink at 4 hours before surgery. The three groups were compared in terms of postoperative blood glucose, insulin resistance, β cell activity, postoperative wound complications, and other clinical outcomes.
RESULTS
The group who received oral carbohydrates at 2 or 4 hours before surgery showed significantly lower insulin resistance than the placebo group (group at 2 hours, 9.0 ± 3.4; group at 4 hours, 15.8 ± 6.9 versus placebo, 30.9 ± 10.5, P < 0.001) and lower β cell activity (207.7 ± 106.7%; group at 4 hours, 243.2 ± 114.9% versus 421.5 ± 209.3%, P < 0.001). Those groups were also significantly less likely than the placebo group to experience preoperative hunger or postoperative hyperglycemia. Among patients who received oral…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 90 participants or records.
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