ORIGINAL SCIENTIFIC REPORT
The Use of a Pre-operative Carbohydrate Drink in Patients
with Diabetes Mellitus: A Prospective, Non-inferiority, Cohort
Michael R. Lafﬁn
Peter A. Senior
Published online: 27 December 2017
Internationale de Chirurgie 2017
Background Pre-operative fasting leads to insulin resistance and increased metabolic stress in non-diabetic patients.
Consumption of a carbohydrate drink may alleviate these deleterious effects. Patients with diabetes mellitus represent
over 15% of the surgical population, yet concerns over hyperglycemia and aspiration have excluded patients with
diabetes mellitus from studies assessing the utility of pre-operative carbohydrate drinks.
Objective To assess for a clinically signiﬁcant increase in pre-operative blood glucose concentration (deﬁned as
[2 mmol/L) in patients with diabetes consuming a pre-operative carbohydrate drink.
Methods A prospective observational non-inferiority cohort study of 106 subjects with diabetes mellitus was
undertaken to assess the effect of consuming a pre-operative carbohydrate drink in surgical patients. All patients with
diabetes mellitus undergoing surgery (including but not limited to cardiac, neurologic, urologic, and general surgical
procedures) were enrolled. Subjects were instructed to consume two carbohydrate-rich drinks, one before sleeping
the evening prior to surgery and another on the day of surgery.
Results In total, 43% of subjects were fully compliant with the pre-operative carbohydrate drink regimen. There were
no signiﬁcant differences between the fully compliant and non-compliant subjects with respect to baseline charac-
teristics. Consumption of a pre-operative carbohydrate drink was determined to be non-inferior to fasting in terms of
pre-operative blood glucose concentration (absolute difference 0.23 mmol/L, 95% CI: -1.00 to 1.45 mmol/L, p
\ 0.01). Neither group was found to be superior in terms of pre-operative blood glucose concentration,
hyperglycemia, or length of stay.
Conclusions These ﬁndings function as a step toward ensuring pre-operative carbohydrate drinks are safe in patients
with diabetes undergoing surgery.
‘Nothing to eat or drink after midnight’ is a pre-operative
order designed to reduce the risk of aspiration . This
instruction is straightforward and allows for ﬂexibility in the
order of operative cases. Recently this practice has been
challenged in non-diabetic patients because a prolonged fast
leads to insulin resistance and a catabolic state . In healthy
patients, a shortened ﬂuid fast before surgery does not result
in an increased risk of aspiration, regurgitation, or morbidity
. Furthermore, a pre-operative carbohydrate drink (PCD)
& Michael R. Lafﬁn
Department of Surgery, 2D, Walter C Mackenzie Health
Sciences Centre, University of Alberta, 8440 - 112 Street,
Edmonton, AB T6G 2R3, Canada
Faculty of Medicine and Dentistry, University of Alberta,
Edmonton, AB, Canada
Division of Endocrinology, University of Alberta, Edmonton,
World J Surg (2018) 42:1965–1970