Metabolic Syndrome and Insulin Resistance

Abstract

Metabolic syndrome represents a constellation of risk factors associated with increased incidence of cardiovascular disease and progression to diabetes mellitus. Insulin resistance, a state of decreased biologic response to physiologic concentrations of insulin, is a key component of this syndrome and seems to be the result of a primary defect at the skeletal muscle glucose transporter. Acute illness and the perioperative period are characterized by a state of insulin resistance that manifests as hyperglycemia and leads to various other metabolic and biochemical alterations that adversely affect end organ function. Hyperglycemia in acutely ill patients adversely affects outcome. Achieving euglycemia seems beneficial in certain clinical situations, but considerable disagreement exists regarding the target blood sugar levels, the duration of therapy, and the modality. Pharmacotherapy, exercise, and nutrition to improve insulin sensitivity seem promising but require further evaluation to confirm their efficacy for perioperative risk reduction. This review discusses the pathophysiology and the clinical implications of metabolic syndrome and insulin resistance in the acutely ill patient with an emphasis on perioperative modulation strategies.

Physiologic considerations of Enhanced Recovery After Surgery (ERAS) programs: implications of the stress response

“…Methods such as HOMA 20 that use these basal levels report results that are very different from studies using the appropriate methods (i.e., the HNC). 18,21 Perioperative elements that contribute to insulin resistance Some preoperative conditions, such as cancer, 22 morbid obesity, 23 metabolic syndrome, 24 diabetes, 25 and Fig. 2 The degree of agreement between the methods for the relative change in insulin sensitivity after surgery using Bland-Altman analysis.…”

Perioperative catabolism

“…24,25 Other factors may also contribute, such as the duration of trauma, 26 bed rest and immobilization, 27 type of anesthesia and analgesia, 28,29 nutrition and preoperative fasting, 30,31 blood loss, 25 physical status, and post-surgery rehabilitation. 32 …”

Glycemic Control in Cardiac Surgery

“…Stress hyperglycemia is caused mainly by the effects of counter-regulatory hormones (catecholamines, growth hormone, and cortisol) and by depletion of the functional reserve of the beta-cells in the Langerhans islets of the pancreas (7). During perioperative period of major surgeries, the counterregulatory hormones and the inflammatory response induced by surgical stress are the most important triggers of hyperglycemia (10). The degree of insulin resistance has been related to the magnitude and endurance of surgical stress.…”