{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T06:58:20Z","timestamp":1767769100261,"version":"3.48.0"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T00:00:00Z","timestamp":1767744000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background\/objectives<\/jats:title>\n                    <jats:p>Preoperative oral carbohydrate alleviates postoperative insulin resistance and enhances recovery. Its utility in type 2 diabetes mellitus (T2DM) is debated due to hyperglycemia risks. Isomaltulose, a low-glycemic-index carbohydrate, has been shown to effectively attenuate postprandial glucose fluctuations and reduce metabolic stress on pancreatic \u03b2-cells in T2DM patients. This study investigated the effects of preoperative oral isomaltulose in patients with T2DM undergoing elective laparoscopic non-gastrointestinal surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>60 T2DM patients were randomized to receive either 300\u202fmL of a solution containing 50\u202fg isomaltulose (isomaltulose group) or plain water (Control group) 2\u20133\u202fh preoperatively. The primary outcome was insulin resistance, assessed by the homeostasis model assessment (HOMA-IR) at 24\u202fh post surgery. Secondary outcomes included perioperative glycemic variability, serum insulin levels, Perlas grade (assessed by pre-anesthesia gastric ultrasound), incidence of regurgitation and aspiration, perioperative subjective comfort scores, postoperative nausea and vomiting incidence (PONV), time of first flatus after surgery, surgical wound complications, length of postoperative hospital stay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Baseline characteristics were comparable. At 24\u202fh postoperatively, the Isomaltulose group exhibited significantly lower HOMA-IR [6.89\u202f\u00b1\u202f3.38 vs. 11.60\u202f\u00b1\u202f4.34; mean difference\u202f=\u202f4.71, 95% CI (2.70, 6.72),\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001] and serum insulin levels [15.59\u202f\u00b1\u202f5.58 vs. 24.54\u202f\u00b1\u202f5.92\u202fmU\/L; mean difference\u202f=\u202f8.94, 95% CI (5.97, 11.92),\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001]. Although overall blood glucose was higher [155.70 (129.60\u2013183.60) vs. 144.0 (113.40\u2013182.25) mg\/dL,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.045], glycemic variability was significantly better [20.54% (16.19\u201326.69) vs. 27.95% (22.89\u201331.78),\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001]. Gastric emptying (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.24), patient comfort, PONV, and gastrointestinal recovery were similar. No regurgitation, aspiration, or serious complications occurred.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In well-controlled T2DM patients, preoperative oral isomaltulose was associated with lower postoperative insulin resistance and reduced glycemic variability, without delaying gastric emptying. These metabolic benefits were accompanied by a transient elevation in pre-induction blood glucose, which should be weighed in clinical decision making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.chictr.org.cn\/index.html<\/jats:ext-link>\n                      , identifier ChiCTR2500098088.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2025.1718843","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T06:54:14Z","timestamp":1767768854000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of preoperative oral isomaltulose on insulin resistance and glycemic variability in patients with type 2 diabetes mellitus: a randomized controlled trial"],"prefix":"10.3389","volume":"12","author":[{"given":"Chenyang","family":"Wang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yue","family":"Shang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiameng","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Sun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhengmin","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Changjun","family":"Gao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,7]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1016\/j.clnu.2021.12.016","article-title":"Preoperative carbohydrate loading before elective abdominal surgery: a systematic review and network meta-analysis of phase II\/III randomized controlled trials","volume":"41","author":"Ricci","year":"2022","journal-title":"Clin Nutr"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"3096","DOI":"10.1111\/jocn.14919","article-title":"Are carbohydrate drinks more effective than preoperative fasting: a systematic review of randomised controlled trials","volume":"28","author":"Noba","year":"2019","journal-title":"J Clin Nurs"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"103140","DOI":"10.1016\/j.dsx.2024.103140","article-title":"Clinical effectiveness and safety of preoperative oral carbohydrate loading in patients with diabetes: a systematic review","volume":"18","author":"Zhao","year":"2024","journal-title":"Diabetes Metab Syndr"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1097\/SLA.0000000000002989","article-title":"Enhanced recovery in patients with diabetes: is it time for a moratorium on use of preoperative carbohydrate beverages?","volume":"269","author":"Rushakoff","year":"2019","journal-title":"Ann Surg"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"4091","DOI":"10.2337\/dc12-2430","article-title":"Increased glycemic variability is independently associated with length of stay and mortality in noncritically ill hospitalized patients","volume":"36","author":"Mendez","year":"2013","journal-title":"Diabetes Care"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1614","DOI":"10.2106\/JBJS.21.00878","article-title":"Serum glucose variability increases the risk of complications following aseptic revision hip and knee arthroplasty","volume":"104","author":"Goh","year":"2022","journal-title":"J Bone Joint Surg Am"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1940","DOI":"10.3390\/nu17111940","article-title":"Impact of isomaltulose on glycemic response in diabetic and healthy populations: a meta-analysis","volume":"17","author":"Chen","year":"2025","journal-title":"Nutrients"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"381","DOI":"10.3390\/nu9040381","article-title":"Low glycemic index prototype isomaltulose-update of clinical trials","volume":"9","author":"Maresch","year":"2017","journal-title":"Nutrients"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1901","DOI":"10.1093\/advances\/nmac057","article-title":"Effect of isomaltulose on glycemic and insulinemic responses: a systematic review and meta-analysis of randomized controlled trials","volume":"13","author":"Xie","year":"2022","journal-title":"Adv Nutr"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1213\/ANE.0b013e31821b98c0","article-title":"Gastric sonography in the fasted surgical patient: a prospective descriptive study","volume":"113","author":"Perlas","year":"2011","journal-title":"Anesth Analg"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e44570","DOI":"10.7759\/cureus.44570","article-title":"Effect of carbohydrate loading in diabetic patients undergoing laparoscopic cholecystectomy: a randomized controlled trial","volume":"15","author":"Yadav","year":"2023","journal-title":"Cureus"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1016\/j.clnu.2012.10.011","article-title":"A meta-analysis of randomised controlled trials on preoperative oral carbohydrate treatment in elective surgery","volume":"32","author":"Awad","year":"2013","journal-title":"Clin Nutr"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1016\/j.clnesp.2025.01.035","article-title":"Different regimens of preoperative carbohydrate loading on insulin resistance: a network meta-analysis","volume":"66","author":"Ping","year":"2025","journal-title":"Clin Nutr ESPEN"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"665","DOI":"10.1016\/j.arth.2024.09.016","article-title":"Effect of preoperative carbohydrate loading on postoperative recovery of individuals who have type 2 diabetes after total knee arthroplasty: a randomized controlled trial","volume":"40","author":"Lai","year":"2025","journal-title":"J Arthroplast"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"733","DOI":"10.1016\/j.clnu.2003.12.007","article-title":"Preoperative oral carbohydrate treatment attenuates endogenous glucose release 3 days after surgery","volume":"23","author":"Soop","year":"2004","journal-title":"Clin Nutr"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1016\/j.bja.2021.12.007","article-title":"Prehabilitation, enhanced recovery after surgery, or both? A narrative review","volume":"128","author":"Gillis","year":"2022","journal-title":"Br J Anaesth"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e38","DOI":"10.2337\/dc15-1891","article-title":"Effects of palatinose and sucrose intake on glucose metabolism and incretin secretion in subjects with type 2 diabetes","volume":"39","author":"Keyhani-Nejad","year":"2016","journal-title":"Diabetes Care"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1780","DOI":"10.1007\/s00125-023-05956-x","article-title":"Incretin hormones and type 2 diabetes","volume":"66","author":"Nauck","year":"2023","journal-title":"Diabetologia"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"48","DOI":"10.6133\/apjcn.2013.22.1.20","article-title":"Oral carbohydrate loading with 18% carbohydrate beverage alleviates insulin resistance","volume":"22","author":"Tamura","year":"2023","journal-title":"Asia Pac J Clin Nutr"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"17521","DOI":"10.1038\/s41598-022-21696-1","article-title":"Effect of pre-operative carbohydrate loading on aspiration risk evaluated with ultrasonography in type 2 diabetes patients: a prospective observational pilot study","volume":"12","author":"Lee","year":"2022","journal-title":"Sci Rep"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"106215","DOI":"10.1016\/j.ijsu.2021.106215","article-title":"Preoperative carbohydrate loading with individualized supplemental insulin in diabetic patients undergoing gastrointestinal surgery: a randomized trial","volume":"98","author":"Li","year":"2022","journal-title":"Int J Surg"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"791","DOI":"10.1007\/s00268-021-06437-1","article-title":"Preoperative carbohydrate drink intake increases glycemic variability in patients with type 2 diabetes mellitus in total joint arthroplasty: a prospective randomized trial","volume":"46","author":"Lee","year":"2022","journal-title":"World J Surg"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1059","DOI":"10.3945\/ajcn.113.076638","article-title":"Comparison of the effects of slowly and rapidly absorbed carbohydrates on postprandial glucose metabolism in type 2 diabetes mellitus patients: a randomized trial","volume":"100","author":"Ang","year":"2014","journal-title":"Am J Clin Nutr"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1111\/jdi.14112","article-title":"Glycemic variability: measurement, target, impact on complications of diabetes and does it really matter?","volume":"15","author":"Mo","year":"2024","journal-title":"J Diabetes Investig"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1175","DOI":"10.1007\/s00125-015-3538-3","article-title":"Upper gastrointestinal motility and symptoms in individuals with diabetes, prediabetes and normal glucose tolerance","volume":"58","author":"Boronikolos","year":"2015","journal-title":"Diabetologia"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"108610","DOI":"10.1016\/j.diabres.2020.108610","article-title":"Gastric emptying in health and type 2 diabetes: an evaluation using a 75 g oral glucose drink","volume":"171","author":"Xie","year":"2021","journal-title":"Diabetes Res Clin Pract"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"3311","DOI":"10.1210\/jc.2018-02736","article-title":"Gastric emptying in patients with well-controlled type 2 diabetes compared with young and older control subjects without diabetes","volume":"104","author":"Watson","year":"2019","journal-title":"J Clin Endocrinol Metab"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1016\/j.jesf.2019.06.001","article-title":"The effects of isomaltulose ingestion on gastric parameters and cycling performance in young men","volume":"17","author":"Miyashita","year":"2019","journal-title":"J Exerc Sci Fit"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1017\/S0007114520000884","article-title":"The effect on satiety of ingesting isosweet and isoenergetic sucrose- and isomaltulose-sweetened beverages: a randomised crossover trial","volume":"124","author":"Mills","year":"2020","journal-title":"Br J Nutr"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1186\/s12871-025-03165-0","article-title":"Clinical value of preoperative oral carbohydrate loading in patients with diabetes: a cross-sectional study","volume":"25","author":"Wang","year":"2025","journal-title":"BMC Anesthesiol"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"e2128886","DOI":"10.1001\/jamanetworkopen.2021.28886","article-title":"Effect of intraoperative dexmedetomidine on recovery of gastrointestinal function after abdominal surgery in older adults: a randomized clinical trial","volume":"4","author":"Lu","year":"2021","journal-title":"JAMA Netw Open"}],"container-title":["Frontiers in Nutrition"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2025.1718843\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T06:54:21Z","timestamp":1767768861000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2025.1718843\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,7]]},"references-count":31,"alternative-id":["10.3389\/fnut.2025.1718843"],"URL":"https:\/\/doi.org\/10.3389\/fnut.2025.1718843","relation":{},"ISSN":["2296-861X"],"issn-type":[{"value":"2296-861X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,7]]},"article-number":"1718843"}}