<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT04438590</url>
  </required_header>
  <id_info>
    <org_study_id>USMKK</org_study_id>
    <nct_id>NCT04438590</nct_id>
  </id_info>
  <brief_title>Kelulut Honey as an Alternate Source of Carbo-Loading in Abdominal Surgery Involving the Digestive System</brief_title>
  <acronym>Kel-Load</acronym>
  <official_title>The Use of Kelulut Honey for Carbohydrate-Loading in the Preoperative Period for Patients Undergoing Abdominal Surgery Involving the Digestive System as Part of Enhanced Recovery After Surgery as Opposed to VALENS® Carborie®Load</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>Universiti Sains Malaysia</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
  </sponsors>
  <source>Universiti Sains Malaysia</source>
  <oversight_info>
    <has_dmc>No</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
    <is_us_export>No</is_us_export>
  </oversight_info>
  <brief_summary>
    <textblock>
      The study aims to identify if Kelulut Honey can be a potential alternative for the use of&#xD;
      preoperative carboloading instead of the commercially available product, Carborie.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      Enhanced Recovery After Surgery is a well-established, evidence based multimodal,&#xD;
      multidisciplinary approach to the care of the surgical patient. The aim of the program, as&#xD;
      per its nomenclature, is to establish a set of protocol to subject the surgical patient to in&#xD;
      order to facilitate recovery, attenuate the metabolic responses from surgery, reduce&#xD;
      complications and ultimately reduce length of stay as well as establish return of&#xD;
      physiological function of the patient in an accelerated fashion.&#xD;
&#xD;
      As mentioned, given that ERAS involves a multimodal, multidisciplinary approach, there are&#xD;
      many aspects and guidelines as to the implementation of ERAS. One particular modern care&#xD;
      change is conversion of the surgical dogma of overnight fasting to carbo-loading; whereby the&#xD;
      patient is subjected to consume a carbohydrate rich drink the evening prior to surgery, and 2&#xD;
      hours prior to induction with anaesthesia. The doctrine of overnight fasting or rather 6-8&#xD;
      hours of fasting has long been the core principal for many anaesthesiologists and surgeons,&#xD;
      given the rationale that this would reduce gastric acidity and volume, thereby reducing the&#xD;
      risk of vomiting and gastric content aspiration. However, modern guidelines have shown that&#xD;
      there are no evidence that shortened fast of 2-3 of oral fluids increase the risk of&#xD;
      aspiration, regurgitation or increase morbidity as compared with fasting after midnight.&#xD;
&#xD;
      The problem with fasting, is that it increases insulin resistance. In line with acute-phase&#xD;
      response, and loss of lean body mass, this will attenuate the affects of prolonged fasting.&#xD;
      So, in an insulin resistant state, cell glucose uptake is reduced, and therefore glycogen&#xD;
      formation reduces, which means, the liver and muscle glycogen storage are depleted.&#xD;
      Hyperglycaemia ensues, due to the enhanced endogenous glucose production. Glucose control&#xD;
      needs to be adequate to avoid risk of surgical complication and mortality.&#xD;
&#xD;
      The benefits of carbo-loading is well documented and the evidence is overwhelming. The&#xD;
      evidence shows that oral ingestion of 50g of Carbohydrate has been shown to release Insulin&#xD;
      similar to that of a mixed meal. The current guideline advocates 100g of carbohydrate&#xD;
      consumed the evening prior to surgery and another 50g 2 hours before surgery. The first dose&#xD;
      is consumed with 800 mL of water, and the subsequent dose with 400mL.&#xD;
&#xD;
      Kelulut honey is a natural product, which contains sugar in the form of fructose and glucose&#xD;
      produced by bees (Meliponini Sp). They have a rapid onset, as they are freely absorbed into&#xD;
      the blood stream without requiring digestion. Honey also has a proven role in facilitating&#xD;
      wound healing, and as an anti-inflammatory, and antibacterial agent. The aim of this study is&#xD;
      to evaluate the use of honey as an alternative to maltodextrin extract for carbo-loading in&#xD;
      patients undergoing elective gastrointestinal surgery (Upper GI and Lower GI) and its&#xD;
      effects.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Completed</overall_status>
  <start_date type="Actual">October 1, 2020</start_date>
  <completion_date type="Actual">November 30, 2021</completion_date>
  <primary_completion_date type="Actual">September 25, 2021</primary_completion_date>
  <phase>N/A</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>Randomized</allocation>
    <intervention_model>Parallel Assignment</intervention_model>
    <primary_purpose>Treatment</primary_purpose>
    <masking>Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)</masking>
  </study_design_info>
  <primary_outcome>
    <measure>Kelulut Honey Improves Insulin Resistance when used as carbo-loading preoperatively</measure>
    <time_frame>48 Hours</time_frame>
    <description>• To compare blood sugar levels between patients receiving Kelulut Honey and Carborie pre, intra, and post operatively.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Kelulut Honey would be completely cleared within 2 hours after consumption when used for carbo-loading preoperatively.</measure>
    <time_frame>2 hours</time_frame>
    <description>• To compare Residual Gastric Volume between patients receiving Kelulut Honey and Carborie preoperatively.</description>
  </primary_outcome>
  <number_of_arms>2</number_of_arms>
  <enrollment type="Actual">64</enrollment>
  <condition>Insulin Resistance</condition>
  <condition>ERAS</condition>
  <arm_group>
    <arm_group_label>Kelulut Honey</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>Medical Grade Kelulut Honey which will be in 2 doses.&#xD;
The first would be diluted to 800 ml of water, and the second dose in 400ml of water.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Carborie</arm_group_label>
    <arm_group_type>Active Comparator</arm_group_type>
    <description>Carborie Load which will be 100g of carbohydrate in 800 ML of water and 50g of carbohydrate in 400ml of water.</description>
  </arm_group>
  <intervention>
    <intervention_type>Dietary Supplement</intervention_type>
    <intervention_name>Kelulut Honey</intervention_name>
    <description>The Substance being tested to be used as an alternative</description>
    <arm_group_label>Kelulut Honey</arm_group_label>
  </intervention>
  <intervention>
    <intervention_type>Dietary Supplement</intervention_type>
    <intervention_name>Carborie</intervention_name>
    <description>The commercially available substance</description>
    <arm_group_label>Carborie</arm_group_label>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria&#xD;
&#xD;
          -  Adult (Age ≥ 18)&#xD;
&#xD;
          -  Elective Surgery with Intraabdominal Involvement&#xD;
&#xD;
        Exclusion Criteria&#xD;
&#xD;
          -  Known Diabetics&#xD;
&#xD;
          -  Fasting Glucose Level &gt; 7 mmol/L&#xD;
&#xD;
          -  ASA &gt; 3&#xD;
&#xD;
          -  On Steroid Treatment&#xD;
&#xD;
          -  Recent Infection Past 3 Months&#xD;
&#xD;
          -  Preoperative Unintentional Weight Loss &gt;10% of usual body weight within 6 months&#xD;
&#xD;
          -  Emergency Surgery&#xD;
&#xD;
          -  Minor (Age &lt; 18)&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>N/A</maximum_age>
    <healthy_volunteers>Accepts Healthy Volunteers</healthy_volunteers>
  </eligibility>
  <location>
    <facility>
      <name>Hospital Universiti Sains Malaysia</name>
      <address>
        <city>Kubang Kerian</city>
        <state>Kelantan</state>
        <zip>16150</zip>
        <country>Malaysia</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>Malaysia</country>
  </location_countries>
  <reference>
    <citation>Liz Goldenberg., Fasting versus Carb-Loading: What's the Evidence for Your Enhanced Recovery after Bariatric Surgery Program?, Bariatric Times. 2018;15(11):28-29</citation>
  </reference>
  <results_reference>
    <citation>Yagci G, Can MF, Ozturk E, Dag B, Ozgurtas T, Cosar A, Tufan T. Effects of preoperative carbohydrate loading on glucose metabolism and gastric contents in patients undergoing moderate surgery: a randomized, controlled trial. Nutrition. 2008 Mar;24(3):212-6. doi: 10.1016/j.nut.2007.11.003. Epub 2007 Dec 21.</citation>
    <PMID>18096368</PMID>
  </results_reference>
  <results_reference>
    <citation>Scott MJ, Fawcett WJ. Oral carbohydrate preload drink for major surgery - the first steps from famine to feast. Anaesthesia. 2014 Dec;69(12):1308-13. doi: 10.1111/anae.12921. Epub 2014 Oct 23. No abstract available.</citation>
    <PMID>25346490</PMID>
  </results_reference>
  <results_reference>
    <citation>Nakamura M, Uchida K, Akahane M, Watanabe Y, Ohtomo K, Yamada Y. The effects on gastric emptying and carbohydrate loading of an oral nutritional supplement and an oral rehydration solution: a crossover study with magnetic resonance imaging. Anesth Analg. 2014 Jun;118(6):1268-73. doi: 10.1213/ANE.0b013e3182a9956f.</citation>
    <PMID>24384864</PMID>
  </results_reference>
  <results_reference>
    <citation>Mustafa MZ, Yaacob NS, Sulaiman SA. Reinventing the Honey Industry: Opportunities of the Stingless Bee. Malays J Med Sci. 2018 Jul;25(4):1-5. doi: 10.21315/mjms2018.25.4.1. Epub 2018 Aug 30.</citation>
    <PMID>30914843</PMID>
  </results_reference>
  <results_reference>
    <citation>Maitra S, Kirtania J, Pal S, Bhattacharjee S, Layek A, Ray S. Intraoperative blood glucose levels in nondiabetic patients undergoing elective major surgery under general anaesthesia receiving different crystalloid solutions for maintenance fluid. Anesth Essays Res. 2013 May-Aug;7(2):183-8. doi: 10.4103/0259-1162.118953.</citation>
    <PMID>25885830</PMID>
  </results_reference>
  <results_reference>
    <citation>Ljungqvist O, Scott M, Fearon KC. Enhanced Recovery After Surgery: A Review. JAMA Surg. 2017 Mar 1;152(3):292-298. doi: 10.1001/jamasurg.2016.4952.</citation>
    <PMID>28097305</PMID>
  </results_reference>
  <results_reference>
    <citation>Lassen K, Soop M, Nygren J, Cox PB, Hendry PO, Spies C, von Meyenfeldt MF, Fearon KC, Revhaug A, Norderval S, Ljungqvist O, Lobo DN, Dejong CH; Enhanced Recovery After Surgery (ERAS) Group. Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg. 2009 Oct;144(10):961-9. doi: 10.1001/archsurg.2009.170.</citation>
    <PMID>19841366</PMID>
  </results_reference>
  <results_reference>
    <citation>Kratzing C. Pre-operative nutrition and carbohydrate loading. Proc Nutr Soc. 2011 Aug;70(3):311-5. doi: 10.1017/S0029665111000450.</citation>
    <PMID>21781358</PMID>
  </results_reference>
  <results_reference>
    <citation>Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N, McNaught CE, Macfie J, Liberman AS, Soop M, Hill A, Kennedy RH, Lobo DN, Fearon K, Ljungqvist O; Enhanced Recovery After Surgery (ERAS) Society, for Perioperative Care; European Society for Clinical Nutrition and Metabolism (ESPEN); International Association for Surgical Metabolism and Nutrition (IASMEN). Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS((R))) Society recommendations. World J Surg. 2013 Feb;37(2):259-84. doi: 10.1007/s00268-012-1772-0. No abstract available.</citation>
    <PMID>23052794</PMID>
  </results_reference>
  <results_reference>
    <citation>Gianotti L, Biffi R, Sandini M, Marrelli D, Vignali A, Caccialanza R, Vigano J, Sabbatini A, Di Mare G, Alessiani M, Antomarchi F, Valsecchi MG, Bernasconi DP. Preoperative Oral Carbohydrate Load Versus Placebo in Major Elective Abdominal Surgery (PROCY): A Randomized, Placebo-controlled, Multicenter, Phase III Trial. Ann Surg. 2018 Apr;267(4):623-630. doi: 10.1097/SLA.0000000000002325.</citation>
    <PMID>28582271</PMID>
  </results_reference>
  <results_reference>
    <citation>Bilku DK, Dennison AR, Hall TC, Metcalfe MS, Garcea G. Role of preoperative carbohydrate loading: a systematic review. Ann R Coll Surg Engl. 2014 Jan;96(1):15-22. doi: 10.1308/003588414X13824511650614.</citation>
    <PMID>24417824</PMID>
  </results_reference>
  <results_reference>
    <citation>Zulkhairi Amin FA, Sabri S, Mohammad SM, Ismail M, Chan KW, Ismail N, Norhaizan ME, Zawawi N. Therapeutic Properties of Stingless Bee Honey in Comparison with European Bee Honey. Adv Pharmacol Sci. 2018 Dec 26;2018:6179596. doi: 10.1155/2018/6179596. eCollection 2018.</citation>
    <PMID>30687402</PMID>
  </results_reference>
  <results_reference>
    <citation>Sudiyatmo, et al., Effects of Preoperative Honey Drink on Gastric Content, Perioperative Discomfort and Insulin Resistance in Patients Undergoing Open Colorectal Surgery a Randomized, Controlled Trial. British Journal of Medicine &amp; Medical Research, 14(7): 1-8, 2016.</citation>
  </results_reference>
  <results_reference>
    <citation>Abdul JA, et al., Surgical Services In Malaysian Hospitals. National Healthcare Establishment &amp; Workforce Statistics (NHEWS) 2011, NCRC/HSU/2013.1 C4:47-63, 2013</citation>
  </results_reference>
  <verification_date>December 2021</verification_date>
  <study_first_submitted>June 16, 2020</study_first_submitted>
  <study_first_submitted_qc>June 18, 2020</study_first_submitted_qc>
  <study_first_posted type="Actual">June 19, 2020</study_first_posted>
  <last_update_submitted>December 26, 2021</last_update_submitted>
  <last_update_submitted_qc>December 26, 2021</last_update_submitted_qc>
  <last_update_posted type="Actual">January 13, 2022</last_update_posted>
  <responsible_party>
    <responsible_party_type>Principal Investigator</responsible_party_type>
    <investigator_affiliation>Universiti Sains Malaysia</investigator_affiliation>
    <investigator_full_name>B. Karthik Krishnan</investigator_full_name>
    <investigator_title>Principal Investigator</investigator_title>
  </responsible_party>
  <keyword>carbohydrate loading</keyword>
  <keyword>honey</keyword>
  <keyword>insulin resistance</keyword>
  <keyword>stingless bee</keyword>
  <keyword>ERAS</keyword>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Insulin Resistance</mesh_term>
  </condition_browse>
  <patient_data>
    <sharing_ipd>Undecided</sharing_ipd>
  </patient_data>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT04438590
org study id: USMKK
nct id: NCT04438590
lead sponsor: 
has dmc: No
is fda regulated drug: No
is fda regulated device: No
is us export: No
The study aims to identify if Kelulut Honey can be a potential alternative for the use of
      preoperative carboloading instead of the commercially available product, Carborie.
Enhanced Recovery After Surgery is a well-established, evidence based multimodal,
      multidisciplinary approach to the care of the surgical patient. The aim of the program, as
      per its nomenclature, is to establish a set of protocol to subject the surgical patient to in
      order to facilitate recovery, attenuate the metabolic responses from surgery, reduce
      complications and ultimately reduce length of stay as well as establish return of
      physiological function of the patient in an accelerated fashion.

      As mentioned, given that ERAS involves a multimodal, multidisciplinary approach, there are
      many aspects and guidelines as to the implementation of ERAS. One particular modern care
      change is conversion of the surgical dogma of overnight fasting to carbo-loading; whereby the
      patient is subjected to consume a carbohydrate rich drink the evening prior to surgery, and 2
      hours prior to induction with anaesthesia. The doctrine of overnight fasting or rather 6-8
      hours of fasting has long been the core principal for many anaesthesiologists and surgeons,
      given the rationale that this would reduce gastric acidity and volume, thereby reducing the
      risk of vomiting and gastric content aspiration. However, modern guidelines have shown that
      there are no evidence that shortened fast of 2-3 of oral fluids increase the risk of
      aspiration, regurgitation or increase morbidity as compared with fasting after midnight.

      The problem with fasting, is that it increases insulin resistance. In line with acute-phase
      response, and loss of lean body mass, this will attenuate the affects of prolonged fasting.
      So, in an insulin resistant state, cell glucose uptake is reduced, and therefore glycogen
      formation reduces, which means, the liver and muscle glycogen storage are depleted.
      Hyperglycaemia ensues, due to the enhanced endogenous glucose production. Glucose control
      needs to be adequate to avoid risk of surgical complication and mortality.

      The benefits of carbo-loading is well documented and the evidence is overwhelming. The
      evidence shows that oral ingestion of 50g of Carbohydrate has been shown to release Insulin
      similar to that of a mixed meal. The current guideline advocates 100g of carbohydrate
      consumed the evening prior to surgery and another 50g 2 hours before surgery. The first dose
      is consumed with 800 mL of water, and the subsequent dose with 400mL.

      Kelulut honey is a natural product, which contains sugar in the form of fructose and glucose
      produced by bees (Meliponini Sp). They have a rapid onset, as they are freely absorbed into
      the blood stream without requiring digestion. Honey also has a proven role in facilitating
      wound healing, and as an anti-inflammatory, and antibacterial agent. The aim of this study is
      to evaluate the use of honey as an alternative to maltodextrin extract for carbo-loading in
      patients undergoing elective gastrointestinal surgery (Upper GI and Lower GI) and its
      effects.
allocation: Randomized
intervention model: Parallel Assignment
primary purpose: Treatment
masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
measure: Kelulut Honey Improves Insulin Resistance when used as carbo-loading preoperatively
time frame: 48 Hours
description: • To compare blood sugar levels between patients receiving Kelulut Honey and Carborie pre, intra, and post operatively.
measure: Kelulut Honey would be completely cleared within 2 hours after consumption when used for carbo-loading preoperatively.
time frame: 2 hours
description: • To compare Residual Gastric Volume between patients receiving Kelulut Honey and Carborie preoperatively.
arm group label: Kelulut Honey
arm group type: Experimental
description: Medical Grade Kelulut Honey which will be in 2 doses.
The first would be diluted to 800 ml of water, and the second dose in 400ml of water.
arm group label: Carborie
arm group type: Active Comparator
description: Carborie Load which will be 100g of carbohydrate in 800 ML of water and 50g of carbohydrate in 400ml of water.
intervention type: Dietary Supplement
intervention name: Kelulut Honey
description: The Substance being tested to be used as an alternative
arm group label: Kelulut Honey
intervention type: Dietary Supplement
intervention name: Carborie
description: The commercially available substance
arm group label: Carborie
criteria: 
gender: All
minimum age: 18 Years
maximum age: N/A
healthy volunteers: Accepts Healthy Volunteers
facility: 
country: Malaysia
citation: Liz Goldenberg., Fasting versus Carb-Loading: What's the Evidence for Your Enhanced Recovery after Bariatric Surgery Program?, Bariatric Times. 2018;15(11):28-29
citation: Yagci G, Can MF, Ozturk E, Dag B, Ozgurtas T, Cosar A, Tufan T. Effects of preoperative carbohydrate loading on glucose metabolism and gastric contents in patients undergoing moderate surgery: a randomized, controlled trial. Nutrition. 2008 Mar;24(3):212-6. doi: 10.1016/j.nut.2007.11.003. Epub 2007 Dec 21.
PMID: 18096368
citation: Scott MJ, Fawcett WJ. Oral carbohydrate preload drink for major surgery - the first steps from famine to feast. Anaesthesia. 2014 Dec;69(12):1308-13. doi: 10.1111/anae.12921. Epub 2014 Oct 23. No abstract available.
PMID: 25346490
citation: Nakamura M, Uchida K, Akahane M, Watanabe Y, Ohtomo K, Yamada Y. The effects on gastric emptying and carbohydrate loading of an oral nutritional supplement and an oral rehydration solution: a crossover study with magnetic resonance imaging. Anesth Analg. 2014 Jun;118(6):1268-73. doi: 10.1213/ANE.0b013e3182a9956f.
PMID: 24384864
citation: Mustafa MZ, Yaacob NS, Sulaiman SA. Reinventing the Honey Industry: Opportunities of the Stingless Bee. Malays J Med Sci. 2018 Jul;25(4):1-5. doi: 10.21315/mjms2018.25.4.1. Epub 2018 Aug 30.
PMID: 30914843
citation: Maitra S, Kirtania J, Pal S, Bhattacharjee S, Layek A, Ray S. Intraoperative blood glucose levels in nondiabetic patients undergoing elective major surgery under general anaesthesia receiving different crystalloid solutions for maintenance fluid. Anesth Essays Res. 2013 May-Aug;7(2):183-8. doi: 10.4103/0259-1162.118953.
PMID: 25885830
citation: Ljungqvist O, Scott M, Fearon KC. Enhanced Recovery After Surgery: A Review. JAMA Surg. 2017 Mar 1;152(3):292-298. doi: 10.1001/jamasurg.2016.4952.
PMID: 28097305
citation: Lassen K, Soop M, Nygren J, Cox PB, Hendry PO, Spies C, von Meyenfeldt MF, Fearon KC, Revhaug A, Norderval S, Ljungqvist O, Lobo DN, Dejong CH; Enhanced Recovery After Surgery (ERAS) Group. Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg. 2009 Oct;144(10):961-9. doi: 10.1001/archsurg.2009.170.
PMID: 19841366
citation: Kratzing C. Pre-operative nutrition and carbohydrate loading. Proc Nutr Soc. 2011 Aug;70(3):311-5. doi: 10.1017/S0029665111000450.
PMID: 21781358
citation: Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N, McNaught CE, Macfie J, Liberman AS, Soop M, Hill A, Kennedy RH, Lobo DN, Fearon K, Ljungqvist O; Enhanced Recovery After Surgery (ERAS) Society, for Perioperative Care; European Society for Clinical Nutrition and Metabolism (ESPEN); International Association for Surgical Metabolism and Nutrition (IASMEN). Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS((R))) Society recommendations. World J Surg. 2013 Feb;37(2):259-84. doi: 10.1007/s00268-012-1772-0. No abstract available.
PMID: 23052794
citation: Gianotti L, Biffi R, Sandini M, Marrelli D, Vignali A, Caccialanza R, Vigano J, Sabbatini A, Di Mare G, Alessiani M, Antomarchi F, Valsecchi MG, Bernasconi DP. Preoperative Oral Carbohydrate Load Versus Placebo in Major Elective Abdominal Surgery (PROCY): A Randomized, Placebo-controlled, Multicenter, Phase III Trial. Ann Surg. 2018 Apr;267(4):623-630. doi: 10.1097/SLA.0000000000002325.
PMID: 28582271
citation: Bilku DK, Dennison AR, Hall TC, Metcalfe MS, Garcea G. Role of preoperative carbohydrate loading: a systematic review. Ann R Coll Surg Engl. 2014 Jan;96(1):15-22. doi: 10.1308/003588414X13824511650614.
PMID: 24417824
citation: Zulkhairi Amin FA, Sabri S, Mohammad SM, Ismail M, Chan KW, Ismail N, Norhaizan ME, Zawawi N. Therapeutic Properties of Stingless Bee Honey in Comparison with European Bee Honey. Adv Pharmacol Sci. 2018 Dec 26;2018:6179596. doi: 10.1155/2018/6179596. eCollection 2018.
PMID: 30687402
citation: Sudiyatmo, et al., Effects of Preoperative Honey Drink on Gastric Content, Perioperative Discomfort and Insulin Resistance in Patients Undergoing Open Colorectal Surgery a Randomized, Controlled Trial. British Journal of Medicine & Medical Research, 14(7): 1-8, 2016.
citation: Abdul JA, et al., Surgical Services In Malaysian Hospitals. National Healthcare Establishment & Workforce Statistics (NHEWS) 2011, NCRC/HSU/2013.1 C4:47-63, 2013
responsible party type: Principal Investigator
investigator affiliation: Universiti Sains Malaysia
investigator full name: B. Karthik Krishnan
investigator title: Principal Investigator
mesh term: Insulin Resistance
sharing ipd: Undecided