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Body mass index predicts insulin sensitivity during cardiac surgery: a prospective observational study

  • Yosuke Nakadate
  • Hiroaki Sato
  • Tamaki Sato
  • Takumi Codere-Maruyama
  • Takashi Matsukawa
  • Thomas Schricker
Reports of Original Investigations

Abstract

Purpose

Taking into account the previously described link between body weight and diabetes mellitus (DM) in non-surgical patients, and the understanding that the degree of intraoperative insulin resistance is a predictor of adverse clinical outcomes, we investigated the relationship between body mass index (BMI) and insulin sensitivity during cardiac surgery.

Methods

We prospectively enrolled 400 patients scheduled for elective cardiac surgery and divided them into groups based on the presence or absence of type-2 DM. They were further categorized into four subgroups based on their BMI: group 1- normal weight, BMI 18.5-24.9 kg·m−2; group 2 - overweight, BMI 25-29.9 kg·m−2; group 3 - obese, BMI 30-34.9 kg·m−2; group 4 - morbidly obese, BMI ≥ 35 kg·m−2. Insulin sensitivity was assessed using the hyperinsulinemic-normoglycemic clamp technique during surgery. We also analyzed the association of BMI, quality of postoperative glycemic control, and postoperative outcomes.

Results

A linear negative relationship between BMI and insulin sensitivity (r = 0.42, P < 0.001) was observed, independent of the patients’ diabetic state. There was also a positive correlation between BMI and postoperative glycemia (r = 0.30, P < 0.001) though the relationship between BMI and major and infectious complication was not significant (P = 0.56, P = 0.10, respectively).

Conclusions

Patient BMI may be used as a simple predictor of insulin sensitivity during cardiac surgery and as a predictor of the quality of postoperative glycemic control. A larger cohort will be necessary to evaluate the association of BMI, perioperative insulin resistance, and clinical outcomes.

L’indice de masse corporelle prédit la sensibilité à l’insuline au cours de la chirurgie cardiaque : étude observationnelle prospective

Résumé

Objectif

En tenant compte du lien déjà décrit entre poids corporel et diabète chez des patients non chirurgicaux et la notion que le niveau de résistance peropératoire à l’insuline est un élément prédictif de résultats cliniques défavorables, nous avons étudié le lien entre l’indice de masse corporelle (IMC) et la sensibilité à l’insuline au cours de la chirurgie cardiaque.

Méthodes

Nous avons recruté de façon prospective 400 patients devant subir une chirurgie cardiaque élective et les avons séparés en groupes en fonction de l’existence ou de l’absence d’un diabète de type 2 (DT2). En outre, ils ont été également classés en quatre sous-groupes en fonction de leur IMC : groupe 1 — poids normal, IMC : 18,5 à 24,9 kg m−2; groupe 2 — surcharge pondérale, IMC : 25 à 29,9 kg m−2; groupe 3 — obésité, IMC : 30 à 34,9 kg m−2; groupe 4 — obésité morbide, IMC > 35 kg m−2. La sensibilité à l’insuline a été évaluée au moyen de la technique du clamp hyperinsulinémique-normoglycémique au cours de l’intervention. Nous avons également analysé l’association de l’IMC, de la qualité du contrôle glycémique postopératoire et de l’évolution postopératoire.

Résultats

Une relation linéaire négative entre l’IMC et la sensibilité à l’insuline (r = 0,42, P < 0,001) a été observée, indépendamment du statut de diabète du patient. Il y a eu aussi une corrélation positive entre l’IMC et la glycémie postopératoire (r = 0,30, P < 0,001) bien que les relations entre l’IMC et les complications majeures ou infectieuses n’aient pas été significatives (respectivement, P = 0,56, P = 0,10).

Conclusions

L’IMC des patients peut être utilisé comme simple facteur prédictif de la sensibilité à l’insuline au cours de la chirurgie cardiaque et comme élément prédictif de la qualité du contrôle glycémique postopératoire. Une plus grande cohorte sera nécessaire pour évaluer l’association entre IMC, résistance à l’insuline périopératoire et l’évolution clinique.

Notes

Conflicts of interest

All authors declare that they have no financial or non-financial interests that may be relevant to the submitted work.

Editorial responsibility

This submission was handled by Dr. Hilary P. Grocott, Editor-in-Chief, Canadian Journal of Anesthesia.

Author contributions

Hiroaki Sato and Thomas Schricker designed the study. Hiroaki Sato, Tamaki Sato, Takumi Codere-Maruyama, and Thomas Schricker acquired data. Yosuke Nakadate, Hiroaki Sato, Tamaki Sato, and Thomas Schricker analyzed and interpreted the data. Yosuke Nakadate, Hiroaki Sato, and Thomas Schricker did statistical analysis. Yosuke Nakadate and Hiroaki Sato drafted the manuscript. All authors critically revised the manuscript and approved the final version.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Copyright information

© Canadian Anesthesiologists' Society 2018

Authors and Affiliations

  1. 1.Department of AnesthesiaMcGill University Health Centre Glen Site, Royal Victoria HospitalMontrealCanada
  2. 2.Department of AnesthesiologyUniversity of YamanashiYamanashiJapan

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