Can pre-operative carbohydrate loading be used in diabetic patients undergoing colorectal surgery? : learning from practice

The introduction of enhanced recovery after surgery (ERAS) has been associated with shortening post-operative recovery. It achieves such outcomes by minimising the physical and physiological trauma of surgery. Benefits include superior pain control, reduced duration of ileus, improved pulmonary function and a reduction in thrombo-embolic and cardiac events. Within the ERAS approach, the role of oral carbohydrate supplements is based on dealing with insulin resistance which characterises periods of stress. Aggressive control of blood glucose levels has been shown to benefit both diabetic and non-diabetic patients admitted to intensive care units, however original studies in this area have not been consistently reproducible. The development of low-osmolality carbohydrate drinks during the mid-1990s opened up the possibility of extending these benefits to surgical patients by providing them with a carbohydrate load two to three hours prior to anaesthesia. The benefits of the ERAS approach to colorectal surgery has been confirmed in several reports. However, its role in diabetic patients has, as yet, received limited attention. This review examines this limited number of publications and considers the potential benefit of pre-operative carbohydrate loading in all diabetic patients.