Prolonged preoperative fasting induces postoperative insulin resistance by ER-stress mediated Glut4 down-regulation in skeletal muscles

Lin, Ming-Chia; Chen, Chih-I; Cheng, Tzu-Ting; Huang, Chien-Chi; Tsai, Jen‐Wei; Feng, Guan‐Ming; Hwang, Tzer‐Zen; Lam, Chen-Fuh

doi:10.7150/ijms.52701

Cited by 11 publications

(7 citation statements)

References 34 publications

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“…One study demonstrated that the mechanism may induces endoplasmic reticulum stress and generates insulin resistance in the skeletal muscle through suppression of Glut4 and inactivation of Ca2+-ATPase, leading to intracellular calcium homeostasis disruption and peripheral insulin resistance. (27). Our studies showed that elderly patients (> 70 years old) who have undergone long-level lumbar surgery minimizing the duration of fasting in surgical patients preand post-surgery is safe and can effectively low down the incidence of electrolyte disorders.…”

Section: Discussionmentioning

confidence: 75%

Retrospective Data Analysis for Enhanced Recovery after Surgery (ERAS) Protocol for Elderly Patients with Long-Level Lumbar Fusion

Wang

Kong

Teng

et al. 2021

Preprint

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Background: Currently, ERAS for spinal surgery field is still in its beginnings, the major protocol lessons learned from other surgical specialties and lack of ERAS program for elderly patients (>70 years old). Geriatric patients has its own special characteristics resulting in more harmed by surgical stress. The enhanced recovery after surgery (ERAS) are designed to improving recovery after surgery and can result in substantial benefits in both clinical outcomes and cost-effectiveness. In the present study, we aimed to determine whether enhanced recovery after surgery (ERAS) significantly improved satisfaction and outcomes in elderly patients (>70 years old) with long-level lumbar fusion. Methods: A total of 154 patients were included, 72 in the ERAS group and 82 case-matched patients in the non-ERAS group. Data including demographic, comorbidity and surgical information were collected from electronic medical records. ERAS interventions were categorised as preoperative, intraoperative and postoperative. We also evaluated primary outcome, surgical complication and length of stay (LOS).Results: There were no statistically significant intergroup differences in regards to demographics, comorbidities, American Society of Anaesthesiologists (ASA) grade, or the number of fusion levels. There were also no differences between mean surgery time of intraoperative blood loss between the ERAS and non-ERAS groups. In addition, the mean preoperative Visual Analogue Score (VAS) for the back and legs and Oswestry Disability Index (ODI) score were not significantly different between the two groups. Overall, ERAS pathway compliance was 91.5%. There were no significant differences in the readmission and mortality rates at 30-day follow-up between the ERAS and non-ERAS groups. However, we observed a statistically significant decrease in the complications in the ERAS group(8 in the ERAS group versus 23 in the non-ERAS group, p=0.009) and LOS in the ERAS group (17.74±5.56 of ERAS group versus 22.13±12.21 in non-ERAS group, p=0.041). Multivariable linear regression showed that comorbidities (p=0.028) and implementation of ERAS program (p=0.002) were correlated with prolonged LOS. Multivariable logistic regression showed that comorbidities (p=0.029)， implementation of ERAS program (p=0.043) and preoperative VAS Back (p=0.046), were correlated with complications. Conclusions: This report describes the first ERAS protocol used in elderly patients after long-level lumbar fusion surgery. Our ERAS program is safe and could help decreases LOS and complication in elderly patients with long-level lumbar fusion.

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Section: Discussionmentioning

confidence: 75%

Retrospective Data Analysis for Enhanced Recovery after Surgery (ERAS) Protocol for Elderly Patients with Long-Level Lumbar Fusion

Wang

Kong

Teng

et al. 2021

Preprint

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“…Therefore, protective interventions seem necessary against these adverse reactions. It should be noted that this study was designed with the assumption that prolonged preoperative fasting time leads to insulin resistance and BS disturbance (43,44); an expectation that was not observed in our cases, as baseline BS and CRP values were normal. This finding indicates that the issue may need more attention among older patients with higher ASA classes, who were routinely scheduled early morning; these cases were excluded from the present study.…”

Section: Discussionmentioning

confidence: 82%

The Effects of Intravenous Vitamin C on Stress Response Severity in Abdominal Hysterectomy Following Prolonged Fasting Time

et al. 2021

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Background: Inevitable prolonged fasting time before surgery leads to inflammatory reactions, surgery-related stress response, and consequently unfavorable outcomes; thus, developing strategies to mitigate these consequences is crucial. Objectives: In this study, we evaluated the effect of ascorbic acid on stress response reduction in abdominal hysterectomy following prolonged fasting time. Methods: Eligible women candidates for abdominal hysterectomy following prolonged fasting time were enrolled in the study and divided into 2 groups of vitamin C [group C; 1 g intravenously (IV) before surgery] and placebo (group P). Before induction of anesthesia, C-reactive protein (CRP), mean arterial pressure (MAP), heart rate (HR), and blood sugar (BS) were measured and compared between the 2 groups at 4-point times, 24 and 48 hours immediately after extubation. Results: Finally, the data of 80 patients were included for the final analysis. A statistically significant difference was observed between the 2 groups in terms of CRP and BS values in T1 CRP serum levels; at the end of the study, CRP values were 0.5 ± 0.55 and 0.92 ± 0.69 in groups C and P, respectively (P = 0.012), and BS levels were 124.12 ± 18.11 and 152.0 ± 17.36 in groups C and P, respectively (P = 0.0001). However, this significant difference was not observed at T2 regarding CRP (P = 0.145) and BS (P = 0.135), as well as at T3 regarding CRP (P = 0.282) and BS (P = 0.213). However, according to both CRP and BS values, the trend of changes from T0 to T3 was significant in the 2 groups (P < 0.0001). Hemodynamic parameters were not significantly different between the 2 groups. No adverse event was reported in the 2 groups. Conclusions: We found that ascorbic acid could induce short-term positive effects in abdominal hysterectomy following prolonged fasting time. Obviously, the optimal dosage, timing, and specific cases that benefit the most from this intervention should be investigated.

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“…Endoplasmic reticulum and inflammatory stress (with reduced GLUT4 expression) have been observed in insulin-resistant skeletal muscle from women with gestational DM, and suppression of ER stress by tauroursodeoxycholic acid (TUDCA) or siRNA knockdown of IRE1A and BIP protein significantly downregulated the activation of ER and inflammatory stress, and increased the GLUT4 expression and glucose uptake [ 68 ]. Interestingly, it was demonstrated that prolonged preoperative fasting in rats induced postoperative ER stress (the activation of IRE1A) and the repression of muscle GLUT4, leading to IR and hyperglycemia [ 69 ]. Finally, a recent study in the brain hippocampus of DM rats has associated the activation of ER stress (BIP, DDIT3 and ATF4) and inflammatory stress (tumor necrosis factor (TNF) and interleukin-6 (IL6)) with reduced GLUT4 expression; furthermore, metformin/donepezil treatment was demonstrated as efficacious to reverse these alterations, becoming a promising way to manage DM-associated dementia [ 70 ].…”

Section: Endoplasmic Reticulum Stress (Er Stress) and Inflammation In Dmmentioning

confidence: 99%

AGEs-Induced and Endoplasmic Reticulum Stress/Inflammation-Mediated Regulation of GLUT4 Expression and Atherogenesis in Diabetes Mellitus

Passarelli

Machado

2021

Cells

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In recent decades, complex and exquisite pathways involved in the endoplasmic reticulum (ER) and inflammatory stress responses have been demonstrated to participate in the development and progression of numerous diseases, among them diabetes mellitus (DM). In those pathways, several players participate in both, reflecting a complicated interplay between ER and inflammatory stress. In DM, ER and inflammatory stress are involved in both the pathogenesis of the loss of glycemic control and the development of degenerative complications. Furthermore, hyperglycemia increases the generation of advanced glycation end products (AGEs), which in turn refeed ER and inflammatory stress, contributing to worsening glycemic homeostasis and to accelerating the development of DM complications. In this review, we present the current knowledge regarding AGEs-induced and ER/inflammation-mediated regulation of the expression of GLUT4 (solute carrier family 2, facilitated glucose transporter member 4), as a marker of glycemic homeostasis and of cardiovascular disease (CVD) development/progression, as a leading cause of morbidity and mortality in DM.

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Prolonged preoperative fasting induces postoperative insulin resistance by ER-stress mediated Glut4 down-regulation in skeletal muscles

Cited by 11 publications

References 34 publications

Retrospective Data Analysis for Enhanced Recovery after Surgery (ERAS) Protocol for Elderly Patients with Long-Level Lumbar Fusion

Retrospective Data Analysis for Enhanced Recovery after Surgery (ERAS) Protocol for Elderly Patients with Long-Level Lumbar Fusion

The Effects of Intravenous Vitamin C on Stress Response Severity in Abdominal Hysterectomy Following Prolonged Fasting Time

AGEs-Induced and Endoplasmic Reticulum Stress/Inflammation-Mediated Regulation of GLUT4 Expression and Atherogenesis in Diabetes Mellitus

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