Guidelines for Application of Continuous Subcutaneous Insulin Infusion (Insulin Pump) Therapy in the Perioperative Period

Boyle, Mary E.; Seifert, Karen M.; Beer, K; Apsey, Heidi A.; Nassar, Adrienne A.; Littman, Stephanie D.; Magallanez, Janice M.; Schlinkert, Richard T.; Stearns, Joshua D.; Hovan, Michael J.; Cook, Curtiss B.

doi:10.1177/193229681200600123

Cited by 45 publications

(39 citation statements)

References 9 publications

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“…[17][18][19][20] Recently, growing attention has been paid to the hyperglycemia control in perioperative patients with diabetes, and experience is gradually being accumulated in this regard. [21][22][23][24][25][26] In our hospital, CSII had been successfully applied to perioperative patients with diabetes for several years, and the management policy is similar to the guidelines published recently. 23 Our results show that there were lower levels and less fluctuation of glucose in the patients of the CSII group.…”

Section: Discussionmentioning

confidence: 99%

“…[21][22][23][24][25][26] In our hospital, CSII had been successfully applied to perioperative patients with diabetes for several years, and the management policy is similar to the guidelines published recently. 23 Our results show that there were lower levels and less fluctuation of glucose in the patients of the CSII group. In addition, no significant difference was observed between the CSII and control groups for occurrence of hypoglycemia, which is similar to other studies.…”

Section: Discussionmentioning

confidence: 99%

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Short-Term Effects of Continuous Subcutaneous Insulin Infusion Therapy in Perioperative Patients with Diabetes Mellitus

Cai

et al. 2013

Diabetes Technology & Therapeutics

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Background: Hyperglycemia is common and hard to control in surgical patients with diabetes. We retrospectively investigated short-term effects of continuous subcutaneous insulin infusion (CSII) in perioperative patients with diabetes. Patients and Methods: Perioperative patients with diabetes discharged between January 1, 2006 and January 1, 2012 were included. Glucose control and postoperative outcomes were compared between the patients using CSII or non-CSII insulin therapy. Results: We identified 108 pairs of patients matched by propensity and surgical category who were using CSII therapy (CSII group) or non-CSII insulin therapy (control group). The CSII group had significantly lower fasting glucose levels (on the first postoperative day, 9.06 -3.09 mmol/L vs. 11.05 -4.19 mmol/L; P = 0.003) and lower mean glucose levels (on the operation day, 9.93 -2.65 mmol/L vs. 12.05 -3.86 mmol/L; P = 0.001). The CSII group also had a lower incidence of fever (on the first postoperative day, 30.4% vs. 53.2%; P = 0.005). Furthermore, patients in the CSII group experienced significantly shorter postoperative intervals for suture removal (P = 0.02) and hospital discharge (P = 0.03). No significant difference in the total medical expenditure was observed between the two groups (P = 0.47). We also made a comparison between the 30 pairs of patients who were using CSII or multiple daily insulin injection therapy but observed no significant difference between these two therapies in glucose control or postoperative outcomes. Conclusions: Compared with non-CSII insulin therapy, even short-term implementation of CSII can improve the postoperative control of glucose, reduce the incidence of postoperative fever, and shorten the time for suture removal and discharge in surgical patients with diabetes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Short-Term Effects of Continuous Subcutaneous Insulin Infusion Therapy in Perioperative Patients with Diabetes Mellitus

Cai

et al. 2013

Diabetes Technology & Therapeutics

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“…However, some considerations should be taken into account. 65,66 A preoperative checklist may be used to assess pump functioning, programmed settings, and supplies. The pump infusion set should be placed away from the surgical field.…”

Section: Intraoperative Considerationsmentioning

confidence: 99%

Ambulatory anesthesia: optimal perioperative management of the diabetic patient

Polderman¹,

Wilpe²,

Eshuis³

et al. 2016

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Given the growing number of patients with diabetes mellitus (DM) and the growing number of surgical procedures performed in an ambulatory setting, DM is one of the most encountered comorbidities in patients undergoing ambulatory surgery. Perioperative management of ambulatory patients with DM requires a different approach than patients undergoing major surgery, as procedures are shorter and the stress response caused by surgery is minimal. However, DM is a risk factor for postoperative complications in ambulatory surgery, so should be managed carefully. Given the limited time ambulatory patients spend in the hospital, improvement in management has to be gained from the preanesthetic assessment. The purpose of this review is to summarize current literature regarding the anesthesiologic management of patients with DM in the ambulatory setting. We will discuss the risks of perioperative hyperglycemia together with the pre-, intra-, and postoperative considerations for these patients when encountered in an ambulatory setting. Furthermore, we provide recommendations for the optimal perioperative management of the diabetic patient undergoing ambulatory surgery.

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“…Emerging data indicate that insulin pumps can be safely allowed in the operating suites and may provide glucose control comparable to intravenous insulin infusions. [2][3][4] Individual institutions are now developing care process models (CPMs) to provide guidance on use of CSII during the perioperative phase of surgical care, 3,5 although some still recommend disconnecting the pump for procedures lasting longer than 3 hours. 6 Despite rising interest in this topic, consensus strategies for maintaining insulin pump systems during surgery continue to lag, and subspecialty organizations and experts remain silent on the topic.…”

mentioning

confidence: 99%

“…5 Initial reports immediately after implementation of the CPM were positive in that necessary elements of management were being accomplished and that CSII therapy appeared to be safe during the perioperative period. 2 We now report on the longerterm performance of the CPM after being applied to a larger number of cases.…”

mentioning

confidence: 99%

Update on a Quality Initiative to Standardize Perioperative Care for Continuous Subcutaneous Insulin Infusion Therapy

Mackey

Thompson

Boyle

et al. 2015

J Diabetes Sci Technol

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Objective: The objective of the analysis was to review the effectiveness of a care process model (CPM) developed to guide management of patients on insulin pump therapy undergoing elective surgical procedures. Methods: Electronic medical records were reviewed to assess the impact of the CPM on documentation of insulin pump status, glucose monitoring, and safety during the perioperative phase of care. Post-CPM care was compared with management provided before CPM implementation. Results: We reviewed 45 cases on insulin pump therapy in the pre-CPM cohort and 106 in the post-CPM cohort. Demographic characteristics, categories of surgery, and perioperative times were not significantly different between the 2 groups. Recommended hemoglobin A1c monitoring occurred in 73% of cases in the pre-CPM cohort but improved to 94% in the post-CPM group ( P < .01). There was a higher frequency of documentation of the insulin pump during the preoperative, intraoperative, and postanesthesia care unit segments of care in the post- vs pre-CPM periods (all P < .01). The number of cases with intraoperative glucose monitoring increased (57% pre-CPM vs 81% post-CPM; P < .01). Glycemic control was comparable between the 2 CPM periods. Hypoglycemia was rare, with only 3 episodes in the pre-CPM group and 4 in the post-CPM. No adverse events associated with perioperative insulin pump use were observed. Conclusions: This analysis adds to previous data on use of insulin pump therapy during the perioperative period. Some processes require additional attention, but data continue to indicate that a standardized approach to care can lead to a successful and safe transition of insulin pump therapy throughout the perioperative period.

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Guidelines for Application of Continuous Subcutaneous Insulin Infusion (Insulin Pump) Therapy in the Perioperative Period

Cited by 45 publications

References 9 publications

Short-Term Effects of Continuous Subcutaneous Insulin Infusion Therapy in Perioperative Patients with Diabetes Mellitus

Short-Term Effects of Continuous Subcutaneous Insulin Infusion Therapy in Perioperative Patients with Diabetes Mellitus

Ambulatory anesthesia: optimal perioperative management of the diabetic patient

Update on a Quality Initiative to Standardize Perioperative Care for Continuous Subcutaneous Insulin Infusion Therapy

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