Effect of glucose load on metabolism in patients with type 2 diabetes during elective surgery using remifentanil-induced anesthesia:a randomized controlled trial

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This study aimed to explore the effect of intraoperative glucose load on metabolism in patients with type 2 diabetes anesthetized with remifentanil. A total of 30 patients were enrolled and randomly allocated to one of two groups:no glucose or low-dose glucose (0.1 g/kg/h for 1 hour followed by 0.05 g/kg/h for 1 hour). Glucose, adrenocorticotropic hormone, 3-methylhistidine, insulin, cortisol, free fatty acid, ketone bodies, and creatinine were measured at several points before, during, and after general anesthesia. Glucose levels in the low-dose glucose group increased significantly at 1 and 2 hours after glucose infusion compared to their preanesthetic levels and to those in the no glucose group. Two patients in the low-dose glucose group had blood glucose levels exceeding 11.1 mmol/L. Free fatty acids, ketone bodies, and 3-methylhistidine/creatinine did not differ significantly between groups. Ketone body levels were significantly higher at 1 hour than preanesthetic levels in both groups;after 1 hour, however, they did not change in the no glucose group but significantly decreased in the low-dose glucose group. Intraoperative low-dose glucose load may suppress ketogenesis, but clinicians must consider the risk of causing hyperglycemia in patients with type 2 diabetes undergoing remifentanil-induced anesthesia. J. Med. Invest. 73 : 222-228, February, 2026