Effects of Preoperative Oral Carbohydrates on Insulin Resistance and Postoperative Recovery in Diabetic Patients Undergoing Coronary Artery Bypass Grafting: A Preliminary Prospective, Single-Blinded, Randomized Controlled Trial.

Abstract

Objective: Previous studies have demonstrated that preoperative oral carbohydrates (CHO) can alleviate postoperative insulin resistance (IR) and enhance recovery in non-diabetic patients undergoing cardiac surgery. However, the potential benefits in diabetic patients remain unclear. This study aimed to investigate the effects of preoperative CHO on IR and postoperative recovery in diabetic patients undergoing off-pump coronary artery bypass grafting (OPCAB).

Design: A prospective, single-center, single-blind, randomized controlled trial.

Setting: The study was conducted in the Adult Cardiac Surgery Ward 6 of a large-volume cardiovascular center.

Participants: A total of 62 consecutive diabetic patients scheduled for isolated OPCAB were prospectively enrolled between July 8, 2022, and April 28, 2023. Participants were randomized in a 1:1 ratio to the CHO group or the control (CTRL) group using computer-generated random numbers.

Interventions: Patients in the CHO group received 335 mL of a carbohydrate drink containing 50 g of carbohydrates 8 to 12 hours before surgery, while those in the CTRL group followed routine fasting protocols.

Measurements and main results: The primary endpoint was postoperative IR, assessed by the homeostasis model assessment. Secondary endpoints included postoperative inflammatory markers and stress responses (e.g., serum cortisol levels), while exploratory endpoints focused on in-hospital clinical outcomes. Baseline characteristics were comparable between groups. CHO administration significantly reduced postoperative inflammatory markers but did not significantly improve IR. Stress response was attenuated in the CHO group, though the difference was not statistically significant. Postoperative drainage was higher in the CHO group, but no differences were observed in other clinical outcomes.

Conclusion: Preoperative CHO may attenuate inflammatory and stress responses without increasing perioperative risk in diabetic patients undergoing OPCAB, although its effect IR remains uncertain.