Randomized clinical trial to compare the effects of preoperative oral carbohydrate versus placebo on insulin resistance after colorectal surgery

Br J Surg. 2010 Mar;97(3):317-27. doi: 10.1002/bjs.6963.


Background: Preoperative oral carbohydrate (OCH) reduces postoperative insulin resistance (PIR). This randomized trial investigated whether this effect is related to insulin-induced activation of the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (PKB) signalling pathway.

Methods: Patients with colorectal cancer scheduled for elective open resection were randomly assigned to preoperative OCH, fasting or placebo. Preoperative general well-being, insulin resistance before and immediately after surgery, and postoperative expression of PI3K, PKB, protein tyrosine kinase (PTK) and glucose transporter 4 (GLUT4) in rectus abdominis muscle were evaluated.

Results: Patient and operative characteristics did not differ between groups. Subjective well-being was significantly better in OCH and placebo groups than in the fasting group, primarily because of reduced thirst (P = 0.005) and hunger (P = 0.041). PIR was significantly greater in fasting and placebo groups (P < 0.010). By the end of surgery, muscle PTK activity as well as PI3K and PKB levels were significantly increased in the OCH group compared with values in fasting and placebo groups (P < 0.050), but GLUT4 expression was unaffected.

Conclusion: PIR involves the PI3K/PKB signalling pathway. Preoperative OCH intake improves preoperative subjective feelings of hunger and thirst compared with fasting, while attenuating PIR by stimulation of the PI3K/PKB pathway.

Trial registration: ClinicalTrials.gov NCT00755729.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Administration, Oral
  • Aged
  • Blood Glucose / metabolism
  • Blotting, Western
  • Carbohydrates / administration & dosage*
  • Colorectal Neoplasms / surgery*
  • Fasting / metabolism
  • Female
  • Glucose Transporter Type 4 / metabolism
  • Humans
  • Insulin / physiology*
  • Insulin Resistance / physiology*
  • Male
  • Middle Aged
  • Phosphatidylinositol 3-Kinases / metabolism*
  • Preoperative Care / methods
  • Proto-Oncogene Proteins c-akt / metabolism*


  • Blood Glucose
  • Carbohydrates
  • Glucose Transporter Type 4
  • Insulin
  • SLC2A4 protein, human
  • Phosphatidylinositol 3-Kinases
  • Proto-Oncogene Proteins c-akt

Associated data

  • ClinicalTrials.gov/NCT00755729