Tesis

Pengaruh Carbohydrate Loading terhadap Kadar Gula Darah Perioperatif dan Resistensi Insulin pada Operasi Elektif Pasien dengan Diabetes Melitus Tipe 2 = The Effects of Preoperative Carbohydrate Loading towards Perioperative Blood Glucose and Insulin Resistance in Type 2 Diabetes Mellitus Patients Underwent Elective Surgery.

Pendahuluan: Praktik pemberian karbohidrat sebelum operasi merupakan hal yang direkomendasikan dalam protokol enhanced recovery after surgery, namun rekomendasi pada populasi diabetes melitus (DM) masih lemah. Hingga sekarang belum ada studi acak tersamar ganda yang meneliti efek loading karbohidrat (CHO) pada populasi DM tipe 2 (DMT2). Penelitian ini bertujuan untuk mengatahui pengaruh pemberian CHO terhadap profil gula darah perioperatif dan resistensi insulin pada populasi DMT2. Metode: Penelitian ini merupakan uji klinis acak tersamar ganda yang melibatkan 44 pasien dewasa dengan DMT2 yang menjalani operasi elektif kategori minor. Subjek dibagi menjadi kelompok kontrol (puasa standar) dan kelompok CHO (diberikan cairan mengandung maltodekstrin 12,5% 200 ml sebelum operasi). Pencatatan terhadap kadar gula darah (GD) pada empat titik waktu pengukuran, yaitu prabedah, 1 jam intrabedah, pascabedah, dan 1 hari pascabedah, serta kadar insulin sebelum dan sesudah operasi. Kejadian hipoglikemia dan hiperglikemia beserta subjek yang mendapat terapi koreksi dicatat. Komplikasi yang direkam meliputi kejadian mual, muntah, aspirasi, infeksi, serta pemajangan lama rawat. Hasil: Kelompok CHO memiliki profil gula darah yang lebih stabil dibandingkan kelompok kontrol (p=0,003) terutama 1 hari pascabedah dengan kelompok CHO memiliki median lebih rendah (137,5 (79–248) vs. 147,0 (88–228)). Kelompok kontrol memiliki fluktuasi gula darah signifikan, terutama antara intrabedah dengan pascabedah dan 1 hari pascabedah. Perbedaan perubahan resistensi insulin tidak berbeda bermakna antarkelompok (p=0,34), namun resistensi insulin kelompok CHO menurun signifikan dari nilai prabedah (p=0,01). Sebanyak 65% subjek kelompok CHO mengalami hiperglikemia dibandingkan 45% pada kontrol. Terdapat 10% subjek dalam kelompok kontrol yang mengalami hipoglikemia, dibanding 0% pada kelompok CHO. Tidak ada kejadian komplikasi dalam penelitian ini. Simpulan: CHO dapat aman diberikan kepada pasien dengan DMT2. Pasien DMT2 yang mendapat CHO memiliki profil kadar gula darah perioperatif lebih stabil dan dapat menurunkan resistensi insulin akibat operasi.
Kata kunci : carbohydrate loading, resistensi insulin, diabetes melitus tipe 2


Introduction: Preoperative carbohydrate loading (CHO) is recommended in enhance recovery after surgery protocol, however, recommendations in type 2 diabetes (T2DM) patients are still controversial. Until now, there were no randomized clinical trial investigating the effects of CHO in T2DM population. This study aimed to evaluate the effects of CHO towards perioperative blood glucose and insulin resistance in T2DM underwent elective surgery. Methods: This is a randomized double-blind clinical trial involving 44 patients allocated to control group (standard fasting) and CHO group (given maltodextrin 12.5% 200 ml preoperative). Blood glucose (BG) was examined at four time points: preloading, 1-hour post-incision, end of surgery and 1 -day post-surgery. Insulin was examined at preloading and end of surgery. Primary outcome was comparison of blood glucose trend and insulin resistance comparison as secondary outcome. Complications recorded including nausea, vomiting, aspiration, infection and prolong hospital stay. Results: The CHO group had a more stable BG profile compared to control (p=0,003) notably at 1-day post-surgery with lower BG median in CHO (137,5 (79– 248) vs. 147,0 (88–228). The control group had significant BG fluctuation, particularly 1 -hour post-incision compared with end of surgery and 1 -day postsurgery. Insulin resistance trend between group were not statistically significant (p=0,34), however insulin resistance in CHO group was significantly lower compared to preloading (p=0,01). About 65% subjects in CHO group had hyperglycemia compared to 45% in control group. There were 10% subjects with hypoglycemia in control group with none in CHO group. There were no complications observed during this study. Conclusion: CHO could be administered safely in patients with T2DM. T2DM patients receiving CHO had more stable perioperative BG profile and could lower insulin resistance due to surgery.
Keywords: carbohydrate loading, insulin resistance, type 2 diabetes mellitus