Resources  |  Diabetes in the Surgical patient – place for Prehab intervention?

Diabetes in the Surgical patient – place for Prehab intervention?

 R. Laza-Cagigas   D. Sumner   T. Rampal 

Around 8 million procedures are performed in the UK with 10-15% of patients having diabetes. These patients are subjected to greater numbers of complications and length of stays. Furthermore, as the population of the UK ages, the likelihood of patients presenting for major oncological surgery while also having either type 1 or type 2 diabetes (T2D) increases, implying an overall greater mortality when compared to those without diabetes.

We identified that a number of patients referred to our Surgical Prehabilitation Service (SPS) suffered from T2D. We explored whether we could offer a multimodal, targeted intervention to make a significant impact on their T2D management. This is particularly relevant in patients presenting for expedited surgery which does not allow time for traditional interventions to have a clinical impact.

We hypothesised that supervised exercise and dietary changes in T2D patients awaiting elective surgery would improve their diabetes management in a short period of time.

Methods

Patients referred to our SPS for optimization before elective surgery who suffered from T2D were offered to enrol in our Prehabilitation Programme.

We measure glycosylated haemoglobin (HbA1c) before and after Prehabilitation to assess changes in T2D management.

The dietary approach included our usual counselling; 1) cutting down on processed foods, 2) reaching a minimum daily protein intake of 1.5 g/kg of ideal body weight,

and as a novelty we asked patients to consider 3) an ad libitum low-carbohydrate high-fat diet.

To provide support for the later, we explained patients how to detect highcarbohydrate sources.

Patients also performed 2 weekly in-hospital sessions of either 30-minute aerobic interval training on a cycle ergometer or 30-minute resistance training. Patients were offered anxiety coping strategies at group sessions as part of the Prehabilitation Programme.

Results

Ten oncology and 1 orthopaedic patients (3 females) with T2D referred to the our SPS for optimization before elective surgery accepted to adopt some dietary changes in form of carbohydrate restriction. After an average span of 6 weeks, HbA1c, weight, and BMI showed reductions. Every patient reduced their HbA1c.

Conclusion

There was demonstrable HbA1c improvement in our 11 patients awaiting elective surgery. These improvements were observed in as short as 2 weeks and allowed patients to eat to satiety while only reducing high-carbohydrate foods intake. Currently, we continue recruiting eligible patients to further assess the reproducibility of our approach.

More focussed studies are required for establishing the efficacy of Prehabilitation interventions on T2D patients.

References

  • Banugo, P., & Amoako, D. (2017). Prehabilitation. Bja Education, 17(12): 401-405
  • Barker, P., Creasey, P. E., Dhatariya, K., Levy, N., Lipp, A., … & Woodcock, T. (2015). Peri‐operative management of the surgical patient with diabetes 2015: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia, 70(12), 1427-1440.
  • Röhling, M., Herder, C., Roden, M., Stemper, T., & Müssig, K. (2016). Effects of long-term exercise interventions on glycaemic control in type 1 and type 2 diabetes: a systematic review. Experimental and Clinical Endocrinology & Diabetes, 124(08), 487-494.
  • McKenzie, A. L., Hallberg, S. J., Creighton, B. C., Volk, B. M., Link, T. M., Abner, M. K., … & Phinney, S. D. (2017). A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes. JMIR diabetes, 2(1), e5-e5.

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