[Perioperative handling of antidiabetic drugs]

Effects of Intravenous Dexamethasone on Glycemic Control in Patients With Type 2 Diabetes Mellitus After Total Knee Arthroplasty

BACKGROUND

We sought to determine whether administrations of intravenous (IV) dexamethasone jeopardize blood glycemic control, increase rates of postoperative complications, and diabetic medication change after TKA.

METHODS

This retrospective study included 427 patients with DM who underwent TKA. Patients were divided into two groups according to the use of IV dexamethasone (Dexa and No Dexa). For the Dexa, IV dexamethasone (5mg) was administered twice (surgery day, postoperative day 1). Blood glucose level until postoperative day 5, whether the mean blood glucose level was ≥200 mg/dL or not, the rate of a diabetic medication change, and postoperative complications (surgical site infection, delayed wound healing) were analyzed.

RESULTS

The adverse effects of IV dexamethasone on glycemic control were limited to the day of injection. The mean blood glucose level was 168.8 mg/dL and 204.4 mg/dL on operation day and 193.0 mg/dL and 210.5 mg/dL on postoperative day 1 in the No Dexa and the Dexa, respectively. High preoperative glycated hemoglobin (HbA1c) levels, but not IV dexamethasone administration, increased the risk of postoperative blood glucose level ≥200 mg/dL (odds ratio [OR], 2.810) and diabetic medication change (OR, 3.635, P < .001). A preoperative HbA1c level of >7.05% was associated with the risk of diabetic medication change. There was increase of postoperative complications (OR, 0.693, P = .552).

CONCLUSIONS

IV dexamethasone have transient effects on increasing the blood glucose level after TKA in patients with DM. However, patients with a preoperative HbA1c level of ≥7.05% may need to change their diabetic medication after TKA, regardless of IV dexamethasone administration.

Encapsulation of cinnamon oil in whey protein counteracts the disturbances in biochemical parameters, gene expression, and histological picture of the liver and pancreas of diabetic rats

This study aimed to evaluate the protective role of encapsulated cinnamon oil emulsion (COE) in whey protein concentrate (WPC) against the disturbance in lipid profile, oxidative stress markers, and gene expression in streptozotocin (STZ)-treated rats. COE was analyzed using GC-MS, and the emulsion was prepared and characterized. In the in vivo study, six groups of male rats were treated orally for 4 weeks, including the control group, the group treated with STZ (D-rats), the groups received a low or high dose of COE (200 or 400 mg/kg B.w.), and the D-rats groups received COE at the low or high dose. Blood and tissue samples were collected after the end of the treatment period for biochemical, genetical, and histological analyses. The GC-MS results revealed that the major components of the oil were cinnamaldehyde, 1,8 cineole, acetic acid, 1,7,7-trimethylbicyclo[2.2.1]hept2yl ester, α-Pinene, and α-Terpineol. The size, zeta potential, and polydispersity index (PDI) of COE were 240 ± 1.03 nm, - 7.09 ± 0.42, and 0.36, respectively. The in vivo results revealed that COE at the two tested doses improved the levels of glucose, insulin, amylase, lipid profile, hepatic MDA, SOD, and GSH. COE also downregulated hepatic GLU2, FAS, SREBP-1c, and PEPCK gene expression and upregulated IGF-1 mRNA expression in diabetic rats in a dose-dependent manner. Moreover, COE improved and the histological picture of the liver and pancreas. It could be concluded that COE overcomes the disturbances in biochemical, cytological, and histopathological changes in D-rats via the enhancement of antioxidant capacity; reduces the oxidative stress; modulates the concerned gene expression; and may be promising to develop new drugs for diabetic treatment.