Cardiac Surgery, Insulin Resistance, Pediatric Cardiac Surgery
Conditions
Keywords
Cardiac surgery, Carbohydrate loading, Insulin resistance, Glycemic variability
Brief summary
Surgical stress and preoperative fasting can induce insulin resistance, characterized by impaired cellular response to insulin and resulting hyperglycemia. In pediatric patients undergoing cardiac surgery, this metabolic stress response may negatively affect postoperative recovery. Although preoperative oral carbohydrate loading, defined as administering a carbohydrate-rich beverage before surgery rather than prolonged fasting, has demonstrated efficacy in reducing postoperative insulin resistance in adults, evidence supporting its use in pediatric cardiac surgery remains limited. This randomized controlled trial aims to determine whether preoperative oral carbohydrate loading reduces perioperative insulin resistance, as measured by the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), in pediatric patients undergoing cardiac surgery. The study will compare outcomes between children who receive an oral carbohydrate beverage prior to surgery and those who follow standard preoperative fasting protocols.
Detailed description
This study is a prospective, single-blind, randomized controlled trial of pediatric patients who underwent elective cardiac surgery at Dr. Sardjito General Hospital, Yogyakarta, Indonesia, from April to August 2026. The study sample consisted of pediatric patients aged 2-16 years with an ASA physical status of 2 or 3 who had good tolerance for enteral fluid administration. Patients will be randomly assigned to one of two groups: 1. Intervention Group (Carbohydrate Loading): 3 mL/kg body weight of a maltodextrin-based carbohydrate drink 2 hours before anesthesia; 2. Control Group (Placebo Loading): 3 mL/kg body weight of plain water 2 hours before anesthesia. All patients will follow standard preoperative fasting guidelines. Blood samples for glucose and insulin testing will be collected immediately after induction (baseline), at 0 hours of Intensive Care Unit (ICU) admission, and at 24 hours of ICU admission. The primary outcome is the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). Secondary outcomes include blood glucose levels, serum insulin concentration, exogenous insulin dose, and glycemic variability. All study participants will undergo preoperative assessment, followed by a carbohydrate-loading protocol, and assessment of blood glucose levels, insulin resistance, exogenous insulin administration, and intraoperative and postoperative glycemic variability. Numerical data will be presented as means and standard deviations. Categorical data will be presented as counts and percentages. The Shapiro-Wilk normality test will be applied to all numerical data. Subject characteristics between the two groups will be compared using the Chi-square test for categorical data and the t-test (for normally distributed data) or the Mann-Whitney test (for non-normally distributed data) for numerical data. Pre- and postoperative HOMA-IR values will be compared using a paired t-test if the data are normally distributed, or a two-way ANCOVA (univariate GLM) if they are not. A p-value \< 0.05 will be considered statistically significant.
Interventions
DIETARY_SUPPLEMENTCarbohydrate
Participants receive 3 mL/kg body weight of a carbohydrate drink 2 hours before anesthesia induction. The drink is used to lower insulin resistance and improve perioperative recovery.
OTHERplacebo solution
Participants receive 3 mL/kg body weight of plain water 2 hours before surgery, following the same timing and fasting protocol as the experimental group.
Sponsors
Rifdhani Fakhrudin Nur
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
2 Years to 16 Years
Healthy volunteers
No
Inclusion criteria
* Age 2-16 years. * ASA physical status 2 or 3 * Good tolerance of enteral feeding
Exclusion criteria
* History of type 1 diabetes mellitus. * History of thyroid insufficiency treated with thyroid medication. * History of adrenal insufficiency treated with corticosteroids. * History of gastroesophageal reflux disease. * Patients receiving preoperative parenteral nutrition. * Emergency or urgent cardiac surgery.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| HOMA-IR (Homeostasis Model Assessment for Insulin Resistance) | Baseline, 0 Hour ICU Admission, 24 hours ICU Admission | The Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) is calculated as fasting insulin (µU/mL) × fasting glucose (mmol/L) / 22.5. Higher values indicate greater insulin resistance. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Blood Glucose Level | Baseline, 0 hour ICU Admission, 24 hours ICU Admission | Blood glucose measured from central venous samples to assess changes in glucose metabolism during and after cardiac surgery. |
| Serum Insulin Concentration | Baseline, 0 hour ICU Admission, 24 hours ICU Admission | Serum insulin level measured from central venous blood samples to characterize perioperative insulin changes. Higher values indicate higher circulating insulin. |
| Exogenous Insulin Dose | Baseline, 0 hour ICU Admission, 24 hours ICU Admission | Total daily dose of exogenous insulin (basal and/or bolus) required to achieve glycemic control will be recorded, expressed in units per day (U/day) or units per kilogram body weight per day (U/kg/day). Change in insulin dose from baseline will be used to reflect changes in insulin requirement/sensitivity. |
| Glycemic Variability | Baseline, 0 Hour ICU Admission, 24 Hours ICU Admission | Glycemic variability is defined as the fluctuation of blood glucose levels during the perioperative period, calculated from serial blood glucose measurements. Variability will be expressed as the standard deviation (SD) and/or coefficient of variation (%CV) of serial glucose values (numeric/continuous scale). Higher SD/CV values indicate greater glycemic fluctuation during the perioperative period. |
Countries
Indonesia
Contacts
CONTACTRifdhani Fakhrudin Nur
Outcome results
None listed