Preoperative Carbohydrate Loading in Diabetic Patients Undergoing Elective Abdominal Surgery

Tanta University120 enrolled

Overview

This study evaluates the effect of preoperative carbohydrate loading on early postoperative recovery in patients with type 2 diabetes mellitus undergoing elective abdominal surgery. Traditionally, patients fast before surgery, which can increase insulin resistance, delay recovery, and worsen postoperative outcomes. Preoperative carbohydrate drinks may reduce surgical stress and improve recovery, but concerns exist regarding blood glucose control and gastric emptying in diabetic patients. In this randomized, double-blind clinical trial, 120 eligible patients will be assigned to three groups: nondiabetic control, nondiabetic with carbohydrate load, and diabetic with carbohydrate load. Patients will receive either a carbohydrate-rich drink or control solution before surgery. Preoperative gastric residual volume will be measured using ultrasound to assess aspiration risk. Blood glucose levels will be measured before and after carbohydrate intake. Postoperative outcomes including metabolic and inflammatory response, nausea and vomiting, length of hospital stay, and time to independent ambulation will be recorded. The study aims to determine whether preoperative carbohydrate loading is safe and beneficial for diabetic patients undergoing elective abdominal surgery.

This prospective randomized controlled double-blinded study will be conducted at Tanta University Hospitals from June 2024 to June 2025. A total of 120 adult patients (aged 21-65 years, ASA I-II) undergoing elective abdominal surgery will be enrolled. Patients will be randomly assigned to one of three groups: nondiabetic control, nondiabetic carbohydrate load, or diabetic carbohydrate load. The primary outcome is preoperative gastric residual volume measured by ultrasound. Secondary outcomes include postoperative metabolic and inflammatory response, perioperative blood glucose levels, incidence of nausea and vomiting, length of hospital stay, and time to independent ambulation. Patients will receive a standardized preoperative meal of yogurt and honey at midnight, with either a clear carbohydrate drink or water administered two hours before anesthesia induction. Gastric ultrasound will be performed pre-induction to assess aspiration risk. Standard general anesthesia protocols will be used, and all patients will be monitored perioperatively. Ethical approval has been obtained, and informed consent will be collected from all participants. Data confidentiality and patient privacy will be strictly maintained.

Study Type

INTERVENTIONAL

Interventions

Standard Preoperative Fasting With WaterBEHAVIORAL

Participants receive 100 ml yogurt mixed with approximately 42 g honey at midnight before surgery. Two hours before induction of anesthesia, they receive 200 ml of clear water. No carbohydrate-rich clear drink is administered preoperatively. This represents the standard preoperative fasting protocol used in the control group.

Preoperative Oral Carbohydrate LoadingBEHAVIORAL

Participants receive 100 ml yogurt mixed with approximately 42 g honey at midnight before surgery. Two hours before induction of anesthesia, they receive 200 ml of a clear carbohydrate drink consisting of 200 ml water with two spoonfuls (approximately 42 g) of honey dissolved. This intervention is administered preoperatively to reduce perioperative insulin resistance and improve metabolic response.

Eligibility

Sex: ALLMin age: 21 YearsMax age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: Adults aged 21-65 years Both males and females American Society of Anesthesiologists (ASA) physical status I-II Scheduled for elective abdominal surgery under general anesthesia Able and willing to provide informed consent Exclusion Criteria: Patient refusal Known liver or renal pathology affecting gastric function Mental dysfunction or cognitive disorders impairing consent or cooperation Increased risk of gastric content aspiration Body mass index (BMI) \< 20 or \> 35 kg/m² Prior upper gastrointestinal surgery Use of medications affecting gastric motility Type 1 diabetes mellitus Type 2 diabetes mellitus treated with insulin Patients with clinical evidence of diabetic gastropathy or autonomic dysfunction

Outcomes

Primary Outcomes

Preoperative Gastric Residual Volume Measured by Ultrasound

Gastric residual volume (GRV) will be assessed preoperatively using gastric ultrasound examination in the right lateral position. Cross-sectional area measurements will be used to calculate gastric volume using a validated formula. This outcome evaluates gastric emptying and aspiration risk prior to anesthesia induction.

Time frame: Preoperative (immediately before induction of anesthesia)

Secondary Outcomes

Postoperative Metabolic and Inflammatory Response (Glasgow Prognostic Score)

The postoperative inflammatory and metabolic response will be assessed using the Glasgow Prognostic Score (GPS), based on C-reactive protein and serum albumin levels.

Time frame: Postoperative period (within 24 hours after surgery)

Perioperative Random Blood Glucose Levels

Random blood glucose (RBG) levels will be measured at three time points: before carbohydrate loading, 2 hours pre-induction, and 6 hours after carbohydrate administration.

Time frame: Preoperative and 6 hours after carbohydrate loading

Incidence of Postoperative Nausea and Vomiting (PONV)

Occurrence of nausea and/or vomiting within the first 24 hours after surgery.

Time frame: Within 24 hours postoperatively

Length of Hospital Stay

Total number of days from surgery until hospital discharge.

Time frame: From surgery until discharge (up to 7 days)

Time to Independent Ambulation

Time required for the patient to achieve independent ambulation following surgery.

Time frame: Within the first 48 hours postoperatively