Management of Hyperglycemia During the Perioperative Period

Pichardo-Lowden, Ariana; Gabbay, Robert A.

doi:10.1007/s11892-011-0239-2

Cited by 37 publications

(25 citation statements)

References 87 publications

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“…[22][23][24][25][26] Some evidence supports implementing glycemic control prior to surgery, 27,28 which suggests that delaying surgery for better glycemic control in the cases of elective surgeries may be a useful option. A randomized prospective study would be needed to address the best course of action once patients without known diabetes are pre-operatively screened for glucose.…”

Section: Discussionmentioning

confidence: 99%

Preoperative glucose as a screening tool in patients without diabetes

Wang

Panizales

Hudson

et al. 2014

Journal of Surgical Research

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Section: Discussionmentioning

confidence: 99%

Preoperative glucose as a screening tool in patients without diabetes

Wang

Panizales

Hudson

et al. 2014

Journal of Surgical Research

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“…Data derive from surgical population including cohorts of patients who underwent mastectomy, operations for hepatobiliary and pancreatic cancer, colorectal procedures, orthopedic spinal surgery, infrainguinal vascular surgery, and total joint arthroplasty. In all of these studies, elevation of blood glucose values was associated with increased risk of surgical site infections [15].…”

Section: Overview Of the Evidence Of Hyperglycemia And Hypoglycemia Imentioning

confidence: 99%

“…The methodology of many studies available to date is limited by their observational and retrospective design; however, the evidence convincingly demonstrates that hyperglycemia is harmful to both critically ill and noncritically ill surgical patients. Peri-, pre-and intraoperative and postoperative hyperglycemia is associated with increased morbidity, decreased survival, and increased utilization resource [6,15]. Data derive from surgical population including cohorts of patients who underwent mastectomy, operations for hepatobiliary and pancreatic cancer, colorectal procedures, orthopedic spinal surgery, infrainguinal vascular surgery, and total joint arthroplasty.…”

Section: Overview Of the Evidence Of Hyperglycemia And Hypoglycemia Imentioning

confidence: 99%

Management of Hyperglycemia in Hospitalized Patients: Noncritical Care Setting

Pichardo-Lowden¹

2014

Frontiers in Diabetes

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Hyperglycemia is a common in-hospital problem and is associated with poor clinical outcomes. A critical review of pertinent studies and peer-reviewed publications related to inpatient glycemia was conducted. Diabetes mellitus is a problem of worldwide proportion that leads to frequent hospitalization. Hyperglycemia is often found in inpatient settings and is associated with increased risk of morbidity and mortality, surgical interventions, in-hospital infections and surgical site infections, higher admission rates to intensive care units (ICUs), increased hospital length of stay, and increased postdischarge care needs. In some studies, improved inpatient glycemia showed a positive impact in clinical outcomes. Attainment of adequate glycemic control requires addressing various clinical scenarios. The approach to hyperglycemia should abide by the principles of provision of adequate insulin regimens that consider the individual clinical situation of patients and aim for safe glucose targets. The control of hyperglycemia in the nonintensive care setting is a relevant clinical problem that requires effective and prudent strategies. This chapter provides an overview of scenarios encountered in general medical and surgical units, offers a practical approach to management of dysglycemia, lists factors contributing to hyperglycemia and hypoglycemia, reviews the recommended targets for treatment, and presents a strategy for transition to outpatient care. The research evidence available suggests that hyperglycemia is associated with poor clinical outcomes in critically and noncritically ill patients. Additionally, tight glycemic control increases the risk for hypoglycemia and mortality, and less stringent glucose targets may result in lower rates of hypoglycemia. Therefore, judicious glucose control, as opposed to stringent near-normal control proposed in previous clinical guidelines and statements, is probably sufficient to prevent poor clinical outcomes related to hyperglycemia in the ICU. The data available in non-ICU settings is less robust; however, good glucose management remains important in hospitalized patients across clinical units and an attentive attitude toward care of inpatient hyperglycemia should prevail among providers.

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“…The highlight of current technological endeavour in diabetology is the creation of a "an artificial pancreas". The intensive care setting with patient´s energy balance under control is ideal for closed-loop system clinical testing and the results are promising also in the perioperative period [26][27][28][29][30][31] . Nevertheless, these technologies are also invasive and expensive.…”

Section: Introductionmentioning

confidence: 99%

Glucose sensing module - is it time to integrate it into real-time perioperative monitoring? An observational pilot study with subcutaneous sensors

Poljakova¹,

Elsikova²,

Chlup³

et al. 2013

BIOMED PAP

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Aims.To explore the feasibility of subcutaneous continuous glucose monitoring (CGM) in perioperative settings and to evaluate the perioperative development of glycaemia in persons with diabetes mellitus or impaired glucose tolerance by means of CGM. Methods. Monitoring by means of Guardian® REAL-Time CGMS (Medtronic, Nortridge, USA) in 20 perioperative periods. Sensor was inserted on the day before surgery and continued for 3 days with some exceptions. Results. Full implementation of the method was successful in the intensive care unit setting only. No electromagnetic interference and no side effects were found. The Wilcoxon signed-rank test revealed no significant difference between sensor and laboratory analyser values. Pearson´s correlation coefficients of the values obtained by sensor and the Wellion Linus glucometer were 0.875 for the whole perioperative period, 0.866 for the intraoperative period and 0.903 for the first perioperative day. A decline in sensor accuracy on the 6 th day was registered in one case. 16 monitored cases (80%) did not meet the criteria for safe plasma glucose range. Hypoglycaemia was found in 4 (20%) cases. There was an association between grade of the perioperative dysglycaemia and need for reoperation within the next 3 months. The most frequent perioperative glycaemic patterns are demonstrated. Conclusion. Subcutaneous CGM is safe offering detailed insight into glucose homeostasis in the dynamic perioperative period. Laboratory confirmation of sensor plasma glucose concentration by approved laboratory analyser is still necessary. The potentional benefits of maintaining patients within a safe glucose range should be comfirmed by future studies.

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Management of Hyperglycemia During the Perioperative Period

Cited by 37 publications

References 87 publications

Preoperative glucose as a screening tool in patients without diabetes

Preoperative glucose as a screening tool in patients without diabetes

Management of Hyperglycemia in Hospitalized Patients: Noncritical Care Setting

Glucose sensing module - is it time to integrate it into real-time perioperative monitoring? An observational pilot study with subcutaneous sensors

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