Effectiveness and Safety of Preoperative Oral Carbohydrates in Enhanced Recovery after Surgery Protocols for Patients with Diabetes Mellitus: A Systematic Review

Table 1

Characteristics of the studies included in the systemic review.

First author, (reference) year, region	Preoperative oral carbohydrate type, time, and quantity	Study population				Outcome indicators	Statistical results	Adverse reactions and safety
		Combined disease	Sample size		Age (year)
			Intervention group	Control group
Breuer et al. [7], 2006, Germany	Oral 400 ml 12.5% carbohydrate beverage 2 hours before surgery	ASA III–IV heart surgery	56	60	64 ± 9 vs 64 ± 10	Preoperative discomfort VAS score, PIR, length of hospital stay, number of deaths during hospital stay	Preoperative discomfort VAS score were all ; PIR was ; length of hospital stay was	No increase in gastric juice volume or other adverse events were observed; one patient in the placebo group died of intestinal cancer in the ward during hospital stay
Gustafsson et al. [8], 2008, Sweden	Oral 400 ml 12.5% carbohydrate-rich beverages	NR	25	10	45–73	The peak blood sugar, the time to reach the peak, the time to restore the baseline glucose concentration, and the time of gastric half emptying	The peak blood sugar after beverage intake of diabetic patients vs health population was 13.4 ± 0.5 vs 7.6 ± 0.5 mM, ; the baseline level restore time was 180 vs 120 min, ; the half emptying time of the stomach was 49.8 ± 2.2 vs 58.6 ± 3.7 min,	No hyperglycemia or aspiration occurred, others were not mentioned
Lu et al. [9], 2015, China	Oral 5% glucose solution 200 ml 2-3 hours before operation	Liver cancer	60	60	56.82 ± 8.23	Thirst, hunger, and anxiety before operation, blood sugar before anesthesia, PIRI complications and hospitalization days after operation	Preoperative thirst/hunger, ; preoperative anxiety, ; blood sugar before anesthesia 8.16 ± 2.20 vs 7.48 ± 2.80 mmol/L, ; PIRI, 3.24 ± 1.07 vs 7.40 ± 3.25, ; hospitalization days after operation 9.46 ± 4.57 vs 10.03 ± 3.46	Incidence of postoperative complication,
He et al. [10], 2017, China	Oral 5% glucose 250 ml 2 hours before operation	Colorectal cancer	64	60	62.3 ± 9.8	FBG on in the morning of operation and on the first day after operation	Operation day morning FBG 6.2 ± 0.5 vs 6.0 ± 0.7, ; the first day after operation FBG 7.5 ± 2.4 vs 9.3 ± 2.6,	NR
Laffin et al. [11], 2018, Canada	Oral 500 ml cranberry cocktail or apple juice 1 hour before bedtime, one night before operation, and 3 hours before operation	Cardiac, neurological, extraurological, and general surgery	46	60	61.8 vs 66.4	Preoperative blood sugar, preoperative incidence of hyperglycemia, length of hospital stay, number of cases of cancelled surgery, incidence of pneumonia after operation, number of deaths in 30 days	The preoperative blood glucose was 8.3 vs 8.1 mmol/L, ; the preoperative incidence of hyperglycemia was 17.4% vs 16.7%, ; the number of cancelled operations was 0; and the hospital stay was 0.48	Incidence of pneumonia after operation was , and no death occurred within 30 days after operation

ASA III-IV, American Society of Anesthesiologists; FBG, fasting blood glucose; NR, not reported; PIR, postoperative insulin resistance; PIRI: postoperative insulin resistance index; VAS, visual analog scale.