Dynamics of carbohydrate metabolism in persons with acute calculous cholecystitis after cholecystectomy under the influence of physical therapy and occupational therapy

Purpose. To determine the dynamics of carbohydrate metabolism in individuals with acute calculous cholecystitis after laparoscopic cholecystectomy under the influence of physical therapy and occupational therapy. To perform a comparative analysis of the dynamics of insulin resistance at the acute, post-acute and long-term stages of rehabilitation. Material & Methods. The study included 120 people with acute calculous cholecystitis aged 18 to 74 years who underwent LHC. People received rehabilitation interventions for 12 months. The main strategies of physical rehabilitation for normalization of carbohydrate metabolism of people after LHC were: support (consultation), reduced energy consumption, healthy eating habits, regular physical activity (strength and aerobic exercise), sleep management, reduction of anxiety and depression. Statistical analysis. The obtained results were processed by mathematical statistics methods using the IBM SPSS Statistics 23 program. The input data were checked for normality of their distribution. For this, the Shapiro-Wilco W-criterion was used. For the indicators that corresponded to the normal distribution, the average (x̅), standard deviation (S) and standard error of the mean (m) was calculated. To assess the significance of the difference, in the presence of a normal distribution of research results, Student's t-test was used for dependent and independent samples; the difference was considered statistically significant at p<0,05. Results. The initial assessment of carbohydrate metabolism in individuals with acute calculous cholecystitis (ACC) demonstrated glucose levels within the normal range, but an increased HOMA-IR index. When assessing the dynamics of carbohydrate metabolism in individuals with ACC 1 month after LHC, no statistically significant (p>0.05) changes were found in the indices either in the control groups or in the main groups. One year after LHC, when assessing the dynamics of carbohydrate metabolism in the control groups according to ACC, no statistically significant (p>0,05) changes were found in any of the control groups. The HOMA-IR index in representatives of the control groups remained above the norm for a year. When assessing the dynamics of carbohydrate metabolism indices one year after LHC in representatives of the main groups with ACC, a statistically significant decrease (p<0.05) in fasting blood insulin and the HOMA-IR index was found in representatives of all main groups relative to the preliminary examination index and compared with the indices of the control groups. Conclusions. Such positive changes in the insulin resistance function one year after cholecystectomy in individuals who received rehabilitation interventions using our technology indicate that the system of exercises using strength exercises and cyclic aerobic exercises and lifestyle modification can influence carbohydrate metabolism even with unfavorable rehabilitation prognosis in individuals with signs of metabolic dysfunction after cholecystectomy. For a significant impact on carbohydrate metabolism in individuals after LHC, a one-month rehabilitation intervention is not enough; statistically significant dynamics in these functions were observed after 12 months of rehabilitation interventions.