Abstract
Purpose
Recent studies have highlighted the importance of understanding trends in blood glucose levels. We examined the differences in blood glucose fluctuations according to the reconstruction method used after distal gastrectomy (DG) in patients with non-diabetic gastric cancer (GC).
Methods
Sixty-one patients who underwent DG followed by either Billroth 1 (B1) or Roux-en-Y (R-Y) reconstruction were enrolled in this study. We used flash continuous glucose monitoring (CGM), a new technique for assessing glycemic control, to document the post-gastrectomy glycemic profile. Immediately before discharge, a CGM sensor was placed subcutaneously to evaluate blood glucose trends for 2 weeks.
Results
The coefficient of variation of glucose levels was significantly higher in the Roux-en-Y (R-Y) group than in the Billroth I (B-I) group (p = 0.0260). The time below range (TBR, glucose levels of < 70 mg/dL) was also significantly higher in the R-Y group (p = 0.0115). Logistic regression analysis revealed that preoperative casual glucose levels of < 100 mg/dL and R-Y reconstruction were independently correlated with risk factors for a postoperative nocturnal TBR of > 30% (p = 0.006 and 0.042, respectively).
Conclusion
Our findings provide new insights into the post-DG reconstruction method selected for patients with non-diabetic gastric cancer by assessing postoperative blood glucose fluctuations using flash CGM.
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Acknowledgements
This work was partially supported by JSPS KAKENHI (Grant Number 18K16324). All authors contributed to the final manuscript.
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Conceptualization: KS and TK; Methodology: KS, TK, EU, and MF; Formal analysis and investigation: KS, HK, AS, and HF; Writing—original draft preparation: KS; Writing—review and editing: TK and DI; Supervision: EO.
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This study conformed to the ethical guidelines of the World Medical Association Declaration of Helsinki. All the patients provided written informed consent for surgery and the use of their clinical data, as required by the Institutional Review Board of the Kyoto Prefectural University of Medicine (ERB-C-975-2).
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Shoda, K., Kubota, T., Ushigome, E. et al. Dynamics of glucose levels after Billroth I versus Roux-en-Y reconstruction in patients who undergo distal gastrectomy. Surg Today 52, 889–895 (2022). https://doi.org/10.1007/s00595-021-02404-4
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DOI: https://doi.org/10.1007/s00595-021-02404-4