Intravenous alanyl-L-glutamine balances glucose-insulin homeostasis and facilitates recovery in patients undergoing colonic resection A randomised controlled trial

BACKGROUNDGlucose and insulin homeostasis are altered in patients undergoing gastro-intestinal tumour resection and affect the postsurgical outcomes.OBJECTIVESTo evaluate the impact of dipeptide alanyl-L-glutamine supplementation on glucose-insulin homeostasis, inflammatory mediators and surgical recovery in patients undergoing colonic cancer resection.DESIGNA randomised controlled trial.SETTINGSoutheast University Affiliated Zhongda Hospital, China, from January 2011 to May 2011.PARTICIPANTSPatients aged 35 to 75 years, ASA physical status I-II, scheduled for elective colon cancer resection.INTERVENTIONSSixty patients were randomised into one of the three groups and received 22.4mlkg(-1) of physiological saline, a 8.5% 18AA-II solution (a compound amino acid) or glutamine 0.5gkg(-1), given 24h before and 1h after the start of the surgical procedure.PRIMARY OUTCOMES MEASUREInsulin resistance index and insulin sensitivity check index. Secondary outcomes included blood glucose, insulin, tumour necrosis factor-alpha (TNF-) and free fatty acid measured at 24h before surgery (T1), 30min before anaesthesia (T2), 2.5h after the beginning of surgery (T3), and 1h (T4) and 24h (T5) after the end of surgery. The time of first passage of wind and the length of hospital stay were recorded.RESULTSIntraoperative and postoperative insulin resistance or calculated insulin sensitivity were worse in the physiological saline and 18AA-II treated patients compared with those treated with glutamine (P<0.05). Blood glucose increased intraoperatively and postoperatively in all three groups compared with baselines (P<0.05), but glutamine attentuated the peak level of blood glucose (P<0.05). Glutamine reduced the intraoperative and postoperative concentrations of TNF- and free fatty acid, (P<0.05), and shortened the time to the first passage of wind after surgery and the length of hospital stay (P<0.05).CONCLUSIONIntravenous supplementation with glutamine balances glucose-insulin homeostasis and facilitates recovery in patients undergoing colon cancer resection.