Post-operative insulin resistance
Abstract
Post-operative insulin resistance (IR) is a recognised marker of surgical stress. However, the reasons underlying post-operative IR and its clinical value are still unclear. IR has been described as a pathological condition, in which organs and tissues fail to respond to the hormone insulin, resulting in acute hyperglycaemia. Post-operative IR in patients without type 2 diabetes has been identified as an independent, negative predictor of post-operative outcome. Studies have shown a direct relationship between post-operative morbidity (including complications from infection) and total mortality in patients with acute hyperglycaemia compared with diabetic patients. IR and stress-induced hyperglycaemia in the early post-operative period may be corrected by insulin infusion; however, this has often been associated with hypoglycaemia. Detection and modification of risk factors in the pre- and intra-operative periods may decrease the frequency of IR and hyperglycaemia and eliminate the use of insulin. In this literature review, the mechanisms underlying the development and prevention of post-operative IR, and its clinical value are discussed. This study demonstrates the relationship between IR and post-operative morbidity, highlighting the benefits of a complex approach to prevent the adverse events of post-operative IR and stress-induced hyperglycaemia.
About the Authors
Irina Aleksandrovna TarasovaRussian Research Surgery Center
Russian Federation
MD, PhD student of the Surgical Department I (Esophageal and Gastric surgery)
Competing Interests:
No conflict of interests
Alexey Leonidovich Shestakov
Russian Research Surgery Center
Russian Federation
MD, Head of the Surgical Department I (Esophageal and Gastric Surgery)
Competing Interests:
No conflict of interests
Vladimir Vladimirovich Nikoda
Russian Research Surgery Center
Russian Federation
MD, Head of Intensive Care Unit I
Competing Interests:
No conflict of interests
References
1. Шестакова М.В., Брескина О.Ю. Инсулинорезистентность: патофизиология, клинические проявления, подходы к лечению. // Consilium medicum. – 2002. – №10. – С.523-527. [Shestakova MV, Brеskina OY. Insulin resistance: pathophysiology, clinical manifestations, treatment approaches. Consilium medicum. 2002;(10):523-7. (In Russ)]
2. Майоров А.Ю. Инсулинорезистентность в патогенезе сахарного диабета 2 типа // Сахарный диабет. – 2011. – Т. 14. – №1. – C. 35-45. [Mayorov AY. Insulin resistance in pathogenesis of type 2 diabetes mellitus. Diabetes mellitus. 2011;14(1):35-45. (In Russ)] doi: 10.14341/2072-0351-6248
3. Himsworth H, Kerr R. Insulin-sensitive and insulin-insensitive types of diabetes mellitus. Clinical Science. 1939;4:119-152.
4. DeFronzo RA, Alvestrand A, Smith D, et al. Insulin resistance in uremia. J Clin Invest. 1981;67(2):563-568. doi: 10.1172/JCI110067
5. Black PR, Brooks DC, Bessey PQ, et al. Mechanisms of Insulin Resistance Following Injury. Ann Surg. 1982;196(4):420-435. doi: 10.1097/00000658-198210000-00005
6. Carter EA. Insulin Resistance in Burns and Trauma. Nutrition Reviews. 2009;56(1):S170-S176. doi: 10.1111/j.1753-4887.1998.tb01636.x
7. Bellodi G, Manicardi V, Malavasi V, et al. Hyperglycemia and prognosis of acute myocardial infarction in patients without diabetes mellitus. The American Journal of Cardiology. 1989;64(14):885-888. doi: 10.1016/0002-9149(89)90836-9
8. Umpierrez GE, Isaacs SD, Bazargan N, et al. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab. 2002;87(3):978-982. doi: 10.1210/jcem.87.3.8341
9. Sato H, Carvalho G, Sato T, et al. The association of preoperative glycemic control, intraoperative insulin sensitivity, and outcomes after cardiac surgery. J Clin Endocrinol Metab. 2010;95(9):4338-4344. doi: 10.1210/jc.2010-0135
10. Kadoi Y. Blood glucose control in the perioperative period. Minerva Anestesiol. 2012;78(5):574-595.
11. McDonnell ME, Umpierrez GE. Insulin therapy for the management of hyperglycemia in hospitalized patients. Endocrinol Metab Clin North Am. 2012;41(1):175-201. doi: 10.1016/j.ecl.2012.01.001
12. Griesdale DE, de Souza RJ, van Dam RM, et al. Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data. CMAJ. 2009;180(8):821-827. doi: 10.1503/cmaj.090206
13. Investigators N-SS, Finfer S, Chittock DR, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360(13):1283-1297. doi: 10.1056/NEJMoa0810625
14. Майоров А.Ю., Урбанова К.А, Галстян Г.Р., и др. Методы количественной оценки инсулинорезистентности // Ожирение и метаболизм. – 2009. – Т. 6. – №2. – C. 19-23. [Mayorov AY, Urbanova KA, Galstyan GR, Mayorov AY, Urbanova KA, Galstyan GR. Methods for guantificative assessment of insulin resistance. Obesity and metabolism. 2009;6(2):19-23. (In Russ)] doi: 10.14341/2071-8713-5313
15. Дедов И.И., Шестакова М.В., Галстян Г.Р., и др. Алгоритмы специализированной медицинской помощи больным сахарным диабетом. Под редакцией И.И. Дедова, М.В. Шестаковой (7-й выпуск) // Сахарный диабет. – 2015. – Т. 18. – №1S – C. 1-112. [Dedov II, Shestakova MV, Galstyan GR, et al. Standards of specialized diabetes care. Edited by Dedov I.I., Shestakova M.V. (7th edition). Diabetes mellitus. 2015;18(1S):1-112.] doi: 10.14341/DM20151S1-112
16. Feldman LS, Delaney CP, Ljungqvist O, Carli F. Society Manual of Enhanced Recovery Programs for Gastrointestinal Surgery: Springer; 2015. doi: 10.1007/978-3-319-20364-5
17. Baban B, Thorell A, Nygren J, et al. Determination of insulin resistance in surgery: the choice of method is crucial. Clin Nutr. 2015;34(1):123-128. doi: 10.1016/j.clnu.2014.02.002
18. Клыпа Т.В., Орехова М.С., Забросаева Л.И. Гипергликемия критических состояний // Сахарный диабет. – 2015. – Т. 18. – №1. – C. 33-41. [Klypa TV, Orehova MS, Zabrosaeva LI. Hyperglycaemia in criticaly ill patients. Diabetes mellitus. 2015;18(1):33-41. (In Russ)] doi: 10.14341/DM2015133-41
19. Гордюнина С.В. Инсулинорезистентность и регуляция метаболизма // Проблемы Эндокринологии. – 2012. – Т. 58. – №3. – C. 31-34. [Gordiunina SV. Insulin resistance in regulation of metabolism. Problems of Endocrinology. 2012;58(3):31-34. (In Russ)] doi: 10.14341/probl201258331-34
20. Ljungqvist O, Nygren J, Thorell A. Insulin resistance and elective surgery. Surgery. 2000;128(5):757-760. doi: 10.1067/msy.2000.107166
21. Barth E, Albuszies G, Baumgart K, et al. Glucose metabolism and catecholamines. Crit Care Med. 2007;35(9 Suppl):S508-518. doi: 10.1097/01.CCM.0000278047.06965.20
22. Tsao TS, Burcelin R, Katz EB, et al. Enhanced Insulin Action Due to Targeted GLUT4 Overexpression Exclusively in Muscle. Diabetes. 1996;45(1):28-36. doi: 10.2337/diab.45.1.28
23. Thorell A, Nygren J, Hirshman MF, et al. Surgery-induced insulin resistance in human patients: relation to glucose transport and utilization. American Journal of Physiology – Endocrinology And Metabolism. 1999;276(4):E754-E761.
24. Makino T, Noguchi Y, Yoshikawa T, et al. Circulating interleukin 6 concentrations and insulin resistance in patients with cancer. Br J Surg. 1998;85(12):1658-1662. doi: 10.1046/j.1365-2168.1998.00938.x
25. Yu W-K. Influence of acute hyperglycemia in human sepsis on inflammatory cytokine and counterregulatory hormone concentrations. World J Gastroenterol. 2003;9(8):1824. doi: 10.3748/wjg.v9.i8.1824
26. Hotamisligil GS, Murray DL, Choy LN, Spiegelman BM. Tumor necrosis factor alpha inhibits signaling from the insulin receptor. Proceedings of the National Academy of Sciences. 1994;91(11):4854-4858. doi: 10.1073/pnas.91.11.4854
27. Аметов А.C., Богданова Л.Н. Гипергликемия и глюкозотоксичность – ключевые факторы прогрессирования сахарного диабета 2-го типа. // Русский медицинский журнал. – 2010. – Т. 18. – №23. – C.1416-1418 [Ametov AS, Bogdanova LN. Hyperglycemia and glucotoxicity-key factors in the progression of diabetes of the 2nd type. Russian medical journal. 2010;18(23):1416-1418 (In Russ)]
28. Sivan E, Boden G. Free fatty acids, insulin resistance, and pregnancy. Curr Diab Rep. 2003;3(4):319-322. doi: 10.1007/s11892-003-0024-y
29. Kolka CM, Richey JM, Castro AV, et al. Lipid-induced insulin resistance does not impair insulin access to skeletal muscle. Am J Physiol Endocrinol Metab. 2015;308(11):E1001-1009. doi: 10.1152/ajpendo.00015.2015
30. McCowen KC, Malhotra A, Bistrian BR. Stress-Induced Hyperglycemia. Critical Care Clinics. 2001;17(1):107-124. doi: 10.1016/s0749-0704(05)70154-8
31. Moghissi ES, Korytkowski MT, DiNardo M, et al. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Endocr Pract. 2009;15(4):353-369. doi: 10.4158/EP09102.RA
32. Jackson RS, Amdur RL, White JC, Macsata RA. Hyperglycemia is associated with increased risk of morbidity and mortality after colectomy for cancer. J Am Coll Surg. 2012;214(1):68-80. doi: 10.1016/j.jamcollsurg.2011.09.016
33. Schlussel AT, Holt DB, Crawley EA, et al. Effects of hyperglycemia and continuous intravenous insulin on outcomes of surgical patients. J Surg Res. 2012;176(1):202-209. doi: 10.1016/j.jss.2011.07.004
34. Monnier L, Mas E, Ginet C, et al. Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetes. JAMA. 2006;295(14):1681-1687. doi: 10.1001/jama.295.14.1681
35. Gustafsson UO, Thorell A, Soop M, et al. Haemoglobin A1c as a predictor of postoperative hyperglycaemia and complications after major colorectal surgery. Br J Surg. 2009;96(11):1358-1364. doi: 10.1002/bjs.6724
36. Duncan AE, Abd-Elsayed A, Maheshwari A, et al. Role of intraoperative and postoperative blood glucose concentrations in predicting outcomes after cardiac surgery. Anesthesiology. 2010;112(4):860-871. doi: 10.1097/ALN.0b013e3181d3d4b4
37. Mohan S, Kaoutzanis C, Welch KB, et al. Postoperative hyperglycemia and adverse outcomes in patients undergoing colorectal surgery: results from the Michigan surgical quality collaborative database. Int J Colorectal Dis. 2015;30(11):1515-1523. doi: 10.1007/s00384-015-2322-7
38. Umpierrez G, Cardona S, Pasquel F, et al. Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial. Diabetes Care. 2015;38(9):1665-1672. doi: 10.2337/dc15-0303
39. Hermanides J, Cohn DM, Devries JH, et al. Venous thrombosis is associated with hyperglycemia at diagnosis: a case-control study. J Thromb Haemost. 2009;7(6):945-949. doi: 10.1111/j.1538-7836.2009.03442.x
40. Lemkes BA, Hermanides J, Devries JH, et al. Hyperglycemia: a prothrombotic factor? J Thromb Haemost. 2010;8(8):1663-1669. doi: 10.1111/j.1538-7836.2010.03910.x
41. Malmstedt J, Wahlberg E, Jorneskog G, Swedenborg J. Influence of perioperative blood glucose levels on outcome after infrainguinal bypass surgery in patients with diabetes. Br J Surg. 2006;93(11):1360-1367. doi: 10.1002/bjs.5466
42. Van den Berghe G, Schetz M, Vlasselaers D, et al. Clinical review: Intensive insulin therapy in critically ill patients: NICE-SUGAR or Leuven blood glucose target? J Clin Endocrinol Metab. 2009;94(9):3163-3170. doi: 10.1210/jc.2009-0663
43. Palermo NE, Gianchandani RY, McDonnell ME, Alexanian SM. Stress Hyperglycemia During Surgery and Anesthesia: Pathogenesis and Clinical Implications. Curr Diab Rep. 2016;16(3):33. doi: 10.1007/s11892-016-0721-y
44. Thorell A, Efendic S, Gutniak M, et al. Insulin resistance after abdominal surgery. Br J Surg. 1994;81(1):59-63. doi: 10.1002/bjs.1800810120
45. Thorell A, Loftenius A, Andersson B, Ljungqvist O. Postoperative insulin resistance and circulating concentrations of stress hormones and cytokines. Clin Nutr. 1996;15(2):75-79. doi: 10.1016/s0261-5614(96)80023-9
46. Koenig RJ, Peterson CM, Jones RL, et al. Correlation of glucose regulation and hemoglobin AIc in diabetes mellitus. N Engl J Med. 1976;295(8):417-420. doi: 10.1056/NEJM197608192950804
47. Gianchandani RY, Saberi S, Patil P, et al. Prevalence and Determinants of Glycemic Abnormalities in Cardiac Surgery Patients without a History of Diabetes: A Prospective Study. Front Endocrinol (Lausanne). 2015;6:125. doi: 10.3389/fendo.2015.00125
48. Clarke RSJ. The Hyperglycaemic Response to Different Types of Surgery and Anaesthesia. BJA: Br J Anaesth. 1970;42(1):45-53. doi: 10.1093/bja/42.1.45
49. Thorell A, Nygren J, Essen P, et al. The metabolic response to cholecystectomy: insulin resistance after open compared with laparoscopic operation. Eur J Surg. 1996;162(3):187-191.
50. Uchida I, Asoh T, Shirasaka C, Tsuji H. Effect of epidural analgesia on postoperative insulin resistance as evaluated by insulin clamp technique. Br J Surg. 1988;75(6):557-562. doi: 10.1002/bjs.1800750618
51. Donatelli F, Vavassori A, Bonfanti S, et al. Epidural anesthesia and analgesia decrease the postoperative incidence of insulin resistance in preoperative insulin-resistant subjects only. Anesth Analg. 2007;104(6):1587-1593, table of contents. doi: 10.1213/01.ane.0000261506.48816.5c
52. Gupta K, Maggo A, Jain M, et al. Blood glucose estimation as an indirect assessment of modulation of neuroendocrine stress response by dexmedetomidine versus fentanyl premedication during laparoscopic cholecystectomy: A clinical study. Anesth Essays Res. 2013;7(1):34-38. doi: 10.4103/0259-1162.113985
53. Naguib AN, Tobias JD, Hall MW, et al. The role of different anesthetic techniques in altering the stress response during cardiac surgery in children: a prospective, double-blinded, and randomized study. Pediatr Crit Care Med. 2013;14(5):481-490. doi: 10.1097/PCC.0b013e31828a742c
54. Jung SM, Cho CK. The effects of deep and light propofol anesthesia on stress response in patients undergoing open lung surgery: a randomized controlled trial. Korean J Anesthesiol. 2015;68(3):224-231. doi: 10.4097/kjae.2015.68.3.224
55. Yamasaki K, Inagaki Y, Mochida S, et al. Effect of intraoperative acetated Ringer's solution with 1% glucose on glucose and protein metabolism. J Anesth. 2010;24(3):426-431. doi: 10.1007/s00540-010-0926-1
56. Yamamoto T, Yoshida M, Watanabe S, Kawahara H. Effects of intraoperative administration of carbohydrates during long-duration oral and maxillofacial surgery on the metabolism of carbohydrates, proteins, and lipids. Oral Maxillofac Surg. 2015;19(4):417-421. doi: 10.1007/s10006-015-0517-2
57. Thorell A, Alston-Smith J, Ljungqvist O. The effect of preoperative carbohydrate loading on hormonal changes, hepatic glycogen, and glucoregulatory enzymes during abdominal surgery. Nutrition. 1996;12(10):v-695. doi: 10.1016/s0899-9007(96)00167-0
58. Ljungqvist O. Modulating postoperative insulin resistance by preoperative carbohydrate loading. Pract Res Clin Anaesthesiol. 2009;23(4):401-409. doi: 10.1016/j.bpa.2009.08.004
59. Ljungqvist O, Nygren J, Thorell A. Modulation of post-operative insulin resistance by pre-operative carbohydrate loading. Proc Nutr Soc. 2002;61(3):329-336. doi: 10.1079/PNS2002168
60. Smith MD, McCall J, Plank L, et al. Preoperative carbohydrate treatment for enhancing recovery after elective surgery. Cochrane Database Syst Rev. 2014(8):CD009161. doi: 10.1002/14651858.CD009161.pub2
Supplementary files
|
|
1. Рисунок 1. Схема развития послеоперационной инсулинорезистентности и гипергликемии | |
| Subject | Инсулинорезистентность; хирургический стресс; стрессовая гипергликемия | |
| Type | рисунок | |
View
(367KB)
|
Indexing metadata ▾ | |
|
|
2. Рис. 1. Схема развития послеоперационной инсулинорезистентности и гипергликемии. | |
| Subject | ||
| Type | Исследовательские инструменты | |
View
(195KB)
|
Indexing metadata ▾ | |
Review
For citations:
Tarasova I.A., Shestakov A.L., Nikoda V.V. Post-operative insulin resistance. Diabetes mellitus. 2017;20(2):119-125. (In Russ.) https://doi.org/10.14341/7637
Views:
24947
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0).
Email this article 
