Key result
Preoperative carbohydrate loading did not significantly affect gastric volume compared to plain water in diabetic and non-diabetic patients, but it significantly increased blood glucose in diabetics.
Why the study?
Preoperative carbohydrate-rich fluids counter catabolism and may be better tolerated, but their effects on gastric volume and blood sugar control compared with plain water in diabetic and non-diabetic patients required evaluation.
Does preoperative oral carbohydrate loading with 50g dextrose affect gastric volume and blood sugar control in diabetic and non-diabetic patients undergoing elective surgery?
RCT (n=240)
Computer-generated random numbers
No
Does preoperative oral carbohydrate loading with 50g dextrose affect gastric volume and blood sugar control in diabetic and non-diabetic patients undergoing elective surgery?
Absolute Event Rate: 31.2% vs 35.3%
p-value: p=0.163
Preoperative carbohydrate loading does not delay gastric emptying in diabetic or non-diabetic patients, but it significantly increases blood glucose levels in diabetics, necessitating careful monitoring and potential insulin administration.
Supports carbohydrate loading safety for gastric volume in diabetics; extends RCT evidence while warranting glucose monitoring.
Background Preoperative fasting for six hours and accepting clear fluids till two hours of surgery is followed as a regular practice. Carbohydrate-rich fluids antagonize catabolism and are claimed to be tolerated better. This study aims to compare the effect of carbohydrate-rich drinks on gastric volume and blood sugar control in diabetic and non-diabetic patients undergoing elective surgery with plain water. Methods Two hundred forty patients aged 40 to 65 undergoing elective surgery under regional anesthesia were randomized into diabetic control, diabetic study, non-diabetic control, and non-diabetic study. Control groups were given 400 ml of plain water, while the study group received 50 grams of dextrose dissolved in 400 ml of water two hours prior to surgery. Gastric volume was evaluated using USG, and thirst and discomfort were assessed using the Likert scale. Perioperatively, blood sugar values were monitored and kept under control using insulin. Results Mean gastric volume (ml) in diabetic control (35.3±12.95 ml), diabetic study (31.2±11.75 ml), non-diabetic control (29±11.42 ml), and non-diabetic study (30.4±9.12 ml) showed no statistically significant difference (p>0.05). Capillary blood glucose (CBG) values two hours post fluid intake showed a significant increase in CBG levels in the diabetic study (183.2±28.67 mg/dl) compared to the diabetic control group (138.66±15.81 mg/dl). The values returned to baseline within six hours. Thirst and discomfort were significantly lower in the study group of diabetic and non-diabetic populations. Conclusion We conclude that carbohydrate loading does not affect gastric volume in diabetics and non-diabetics. However, the sugar values do increase which may warrant hourly checking and administration of insulin in diabetics.
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Gayathri et al. (2023) conducted an RCT in Type 2 diabetes mellitus and non-diabetic patients undergoing elective surgery (n=240). Preoperative carbohydrate loading vs. 400 ml of plain water was evaluated on Mean gastric volume (ml) evaluated using ultrasound 2 hours post fluid intake in diabetic patients (p=0.163). Preoperative carbohydrate loading did not significantly affect gastric volume compared to plain water in diabetic and non-diabetic patients, but it significantly increased blood glucose in diabetics.
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