Role of Preoperative Carbohydrates Drinks, Dichloroacetate and Exercise on Postoperative Muscle Insulin Resistance

Phase 4

• Conditions: Insulin Resistance
• Interventions: Dietary Supplement: Carbohydrate drinks; Behavioral: Moderate intensity exercise; Drug: Dichloroacetate

• Registration Number: NCT02469337
• Lead Sponsor: University of Nottingham

Brief Summary

The aim of the study is to investigate whether preoperative interventions such as carbohydrate drinks, Dichloroacetate and exercise would inhibit or reverse the changes in molecular mechanisms regulating muscle carbohydrate oxidation and postoperative muscle insulin resistance in patients undergoing major abdominal surgery.

Detailed Description

Forty patients undergoing open elective gastrointestinal surgery, will be randomized to four groups of 10 each. The patients will be randomised to receive either preoperative (1) oral carbohydrate drinks (CHO) or (2) infusion of Dichloroacetate with oral carbohydrate drinks (3) exercise or (4) standard care.

Since the interventions are qualitatively different and only the physiological mechanisms are being studied rather than the clinical outcomes, the study is not blinded and no placebo is used.

Analysis for cytokines, insulin, glucagon levels will be performed at screening, during surgery and on the 2nd postoperative day. Muscle biopsies will be taken at the beginning and end of surgery, from rectus abdominus and vastus lateralis muscles for analysis of mRNA (IL-6, TNF-α, Akt1, IRS-1, FOXO1, MAFbx, MURF1 and PDK4) and protein (MafBx, FOXO1, PDK4) expression and muscle metabolites (glycogen, lactate, triglycerides and FFA). Oral Glucose Tolerance Test (GTT) to be performed at the screening visit and on the 2nd postoperative day using a standard protocol. The techniques to be employed to study the above will include RT-PCR, radioimmunoassay, spectophotometry, bioluminometry, Western blotting and ELISA.

Primary outcome: The changes in indices of muscle insulin resistance and muscle protein breakdown at the beginning and at the end of surgery, in response to surgical stress.

Secondary outcomes: (a) The expression of muscle metabolites, reflecting muscle protein turnover (b) Clinical Outcomes: Length of stay and incidence of postoperative complications.

Study Timeline

• Study Start: 2012-05
• Study First Submitted: 2015-06-08
• Study First Submitted QC: 2015-06-08
• Study First Posted: 2015-06-11
• Status Verified: 2017-01
• Last Update Submitted: 2017-01-04
• Last Update Posted: 2017-01-05
• Primary Completion: 2017-06
• Study Completion: 2017-06

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 40

Inclusion Criteria

• All patients over 18 years of age, who are undergoing major elective open abdominal surgery will be included in the study. Patients should be able to provide a written informed consent to participate in the study.

Exclusion Criteria

• Patients who are

  1. Undergoing emergency surgery
  2. Suffering from chronic illness, (e.g. diabetes) or other debilitating diseases
  3. On long term anti-inflammatory drugs, (e.g. NSAIDS, Steroids, immunosuppressant)
  4. On long term antibiotics
  5. On Statins
  6. On full therapeutic dose of anticoagulants, or aspirin >325 mg/day, Clopidrogel >75mg/day
  7. Suffering from bleeding diathesis
  8. Unable to give consent
  9. Pregnant or breastfeeding.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Preoperative carbohydrate drinks	Carbohydrate drinks	Patients who were randomised to carbohydrate group ingested 800ml PreOp (Nutricia Clinical Care, 12.5g CHO/100 ml) the night before and 400ml in the morning of surgery, about 2-3 hours before the induction of anaesthesia.
Moderate intensity exercise	Moderate intensity exercise	Patients randomised to exercise group, will perform a 30 min exercise using a semi-recumbent exercise bike, at about 70% of their age estimated heart rate(determined by the formula: (220-Age)\*0.7 under close supervision and monitoring of their vital parameters.
Dichloroacetate infusion	Dichloroacetate	The patients in the dichloroacetate group received the CHO drinks as well as an intravenous infusion of DCA (50mg/kg body weight) over 45 min, one- two hours before the induction of anaesthesia.

Primary Outcome Measures

Name	Time	Method
insulin resistance	48 hours after surgery	Relative changes in indices of muscle insulin resistance namely PDC activity, PDK4 mRNA and protein expression.

Secondary Outcome Measures

Name	Time	Method
muscle carbohydrate oxidation	48 hours after surgery	Changes in muscle metabolites such as glycogen, glucose, lactate, reflecting the changes in skeletal muscle carbohydrate oxidation.
Mitochondrial ATP production	48 hours after surgery	Mitochondrial ATP production rates in patients undergoing major abdominal surgery.

Trial Locations

Locations (1)

University Hospitals Nottingham Queen's Medical Centre; 🇬🇧 Nottingham, United Kingdom