Perioperative Glucose and Insulin Changes in Major Urologic Surgeries

Study Overview
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Brief Summary
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Urological surgery patients will have their blood glucose measured before, during, and after surgery. Blood glucose will be measured using a continuous glucose monitor (CGM) device. We hypothesize the presence of a hyperglycemic state towards the end of surgery due to increased metabolic demand.

Detailed Description
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Surgical stress causes acute insulin resistance, increased circulating free-fatty acids, and reduced blood glucose uptake resulting in hyperglycemia. Intraoperative and postoperative glucose levels are typically only monitored in the diabetic or cardiac surgical patient. There is a lack of data on perioperative glucose levels in most prolonged surgeries and thus a barrier in determining the best glycemic management strategy to prevent or resolve acute insulin resistance and hyperglycemia. Obtaining blood glucose by CGM is less invasive and will avert disruption of current surgical pathways and standards of care while also producing reliable glucose measurements.

Official Title
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Perioperative Glucose and Insulin Changes in Major Urologic Surgeries

Conditions
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Urologic Diseases, Surgery, Blood Glucose, High

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult (≥18 years) undergoing a major urologic surgery (proposed case duration >4 hours) at The University of Kansas Medical Center (KUMC) English speaking Exclusion Criteria: Diagnosis of Type 1 or Type 2 diabetes mellitus or an A1C > 6.5% Pregnant or lactating Known allergy to milk, soy, egg, wheat, peanuts, or tree nuts Swallowing difficulties

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Urologic surgery patients<br> | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To determine the perioperative glycemic changes longitudinally in patients undergoing major urologic surgeries. | Interstitial blood glucose levels measured by Continuous Glucose Monitor (CGM) device, in mg/dL | Perioperatively up to post-operative day 4 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To determine the effect of perioperative insulin levels on glycemic variations in patients undergoing major urologic surgeries. | Serum insulin in uIU/mL will be measured from participant blood samples | Perioperatively up to post-operative day 4 | 
| To determine the effect of perioperative insulin, C-peptide, and Free-Fatty Acid (FFA) | C-peptide in ng/mL will be measured from participant blood samples | Perioperatively up to post-operative day 4 | 
| To determine the effect of perioperative insulin, C-peptide, and Free-Fatty Acid (FFA) | FFA in mmol/L will be measured from participant blood samples | Perioperatively up to post-operative day 4 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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surgery, blood glucose, continuous glucose monitoring