Postoperative Glycemia in Patients with Diabetes Maintained on Continuous Subcutaneous Insulin Infusion during Same Day Surgery Admission

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 281-290-Comparative Effectiveness/Health Outcomes/Quality Improvement/Patient or Provider Education/Endocrine Emergencies
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-284
Sandra Indacochea Sobel*1, Marilyn Augustine1, Amy Calebrese Donihi2, David Miller1, Jodie Alton Reider1, Patrick Forte1 and Mary T Korytkowski1
1University of Pittsburgh Medical Center, Pittsburgh, PA, 2University of Pittsburgh School of Pharmacy, Pittsburgh, PA
Glycemic control during the perioperative period impacts surgical outcomes and risk for postoperative complications, especially in people with diabetes. General anesthesia is associated with greater increases in intra- and post-operative blood glucose levels than regional anesthesia in people with and without diabetes. We previously demonstrated that in patients with diabetes who use continuous subcutaneous insulin infusion (CSII), a perioperative glycemic management protocol (PGMP) permitting protocol guided continuation of CSII is safe in patients admitted for same day surgery (SDS). The objective of this quality improvement project was to evaluate postoperative glycemic control in patients who maintained CSII therapy during major and minor surgical procedures.

All patients using CSII admitted to the SDS unit between June 2011 and December 2012 were included. Patient records were reviewed for glycemic variables and clinical outcomes in the perioperative period. Results from patients receiving general anesthesia (GA), defined as anesthesia inducing an unconscious state, were compared to those receiving regional anesthesia (RA).  

43 patients using CSII underwent 51 surgeries. Of these, 35 procedures were done under GA and 16 under RA.  57.1% of surgeries requiring GA and 93.8% requiring RA continued CSII alone throughout the perioperative period.  In the surgeries where patients were kept on CSII alone (n=36), 64% were female, 53% had T1DM. There were no significant differences in age, BMI, diabetes duration, or average total daily basal insulin dose between the GA and RA groups. Those receiving GA had a lower A1C than those receiving RA (7.3 ± 0.9 vs. 8.2 ± 1.0%, p<0.05). There was no statistically significant difference between the groups in average surgery length (GA, 73.9 ± 48.5 vs. RA, 73.5 ± 51.9 minutes), mean glucose on admission to the SDS unit (GA, 164.6 ± 49.3 vs. RA, 193.5 ± 86.7 mg/dL) or mean first postoperative glucose (GA, 176.3 ±65.7 vs. RA, 158.3 ± 57.2 mg/dL). There were no recorded perioperative CSII malfunctions and there was no CSII associated hypoglycemia.

Allowing patients to continue their CSII according to a PGMP during surgical procedures using GA or RA with operative times of 11 to 212 minutes is effective in maintaining satisfactory glycemic control (blood glucose <200 mg/dL), regardless of the type of anesthesia used.

Nothing to Disclose: SIS, MA, ACD, DM, JAR, PF, MTK

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