Perioperative insulin therapy using a closed-loop artificial endocrine pancreas after hepatic resection

Takehiro Okabayashi, Hiromichi Maeda, Zhao Li Sun, Robert A. Montgomery, Isao Nishimori, Kazuhiro Hanazaki

Research output: Contribution to journalReview article

Abstract

Postoperative hyperglycemia is common in critically ill patients, even in those without a prior history of diabetes mellitus. It is well known that hyperglycemia induced by surgical stress often results in dysregulation of liver metabolism and immune function, impairing postoperative recovery. Current evidence suggests that maintaining normoglycemia postoperatively improves surgical outcome and reduces the mortality and morbidity of critically ill patients. On the basis of these observations, several large randomized controlled studies were designed to evaluate the benefit of postoperative tight glycemic control with intensive insulin therapy. However, intensive insulin therapy carries the risk of hypoglycemia, which is linked to serious neurological events. Recently, we demonstrated that perioperative tight glycemic control in surgical patients could be achieved safely using a closed-loop glycemic control system and that this decreased both the incidence of infection at the site of the surgical incision, without the appearance of hypoglycemia, and actual hospital costs. Here, we review the benefits and requirements of perioperative intensive insulin therapy using a closed-loop artificial endocrine pancreas system in hepatectomized patients. This novel intensive insulin therapy is safe and effectively improves surgical outcome after hepatic resection.

Original languageEnglish (US)
Pages (from-to)4116-4121
Number of pages6
JournalWorld Journal of Gastroenterology
Volume15
Issue number33
DOIs
StatePublished - 2009

Keywords

  • Artificial pancreas
  • Hepatic resection
  • Hyperglycemia
  • Intensive insulin therapy
  • Surgical site infection

ASJC Scopus subject areas

  • Gastroenterology

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