Perioperative Blood Glucose Monitoring in the General Surgical Population

Raju, Tejal A.; Torjman, Marc C.; Goldberg, Michael E.

doi:10.1177/193229680900300607

Cited by 26 publications

(23 citation statements)

References 64 publications

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“…Previous results had raised concerns pertaining to their accuracy in acute care settings [81]. A recent analysis of two prospective randomized trials demonstrated both accuracy and safety of SQ continuous glucose monitoring systems in critically ill patients [82•].…”

Section: Continuous Glucose Monitoring and Closed-loop Systemsmentioning

confidence: 99%

Management of Hyperglycemia During the Perioperative Period

Pichardo-Lowden

Gabbay

2011

Curr Diab Rep

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Hyperglycemia is frequently encountered in the inpatient setting and is distinctly associated with poor clinical outcomes. Recent literature suggests an association between stringent glycemic control and increased mortality, thus keeping optimal glycemic targets a relevant subject of debate. In the surgical population, hyperglycemia with or without diabetes mellitus may be unrecognized. Factors contributing to hyperglycemia in the hospital include critical illness, use of certain drugs, use of enteral or parenteral nutrition, and variability in oral or nutritional intake as can occur when patients are prepared for procedures or surgery. A sensible approach to managing hyperglycemia in this population includes preoperative recognition of diabetes mellitus and risks for inpatient hyperglycemia. Judicious control of glycemia during the pre-, intra-, and postoperative time periods with avoidance of hypoglycemia mandates the need for a strategy for patient management that extend to time of discharge. We review the consequences of uncontrolled perioperative hyperglycemia, discuss current clinical guidelines and recent controversies, and provide practical tools for glycemic control in the surgical population.

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Section: Continuous Glucose Monitoring and Closed-loop Systemsmentioning

confidence: 99%

Management of Hyperglycemia During the Perioperative Period

Pichardo-Lowden

Gabbay

2011

Curr Diab Rep

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“…Hyperglycaemia and/or insulin resistance has been shown to adversely affect clinical outcomes in both diabetic and non-diabetic patients [1]. This has been confirmed for several patient categories, including pregnant women [2], patients with diabetes mellitus [3], acute myocardial infarction [4] and acute stroke [5].…”

Section: Introductionmentioning

confidence: 70%

Reduction of glucose and insulin concentrations during in vitro incubation of human whole blood at different temperatures

Beitland

Opdahl²,

Aspelin³

et al. 2013

J Diab Res Clin Met

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Background: Incubation of human whole blood at body temperature has been used in numerous studies without addition of glucose and insulin. The purpose of the study was to examine glucose concentration changes during in vitro incubation of human whole blood at different temperatures, and whether it was affected by addition of insulin and bacterial endotoxin. We also wanted to quantify changes in endogenous insulin concentrations during incubation for six hours at 37 ºC. Methods: Young, healthy and fasting males donated whole blood. Glucose concentrations were compared at baseline and after six hours incubation at 37 ºC, 22 ºC or 0 ºC, in aliquots with and without addition of insulin and bacterial endotoxin. Glucose data are presented as mean (± 1 standard deviation). Endogenous insulin concentrations in aliquots without addition were measured at baseline and after six hours incubation at 37 ºC, data are shown as median (interquartile range). Results: Glucose concentration at baseline was 5.3 (± 0.6) mmol/L. After incubation for six hours at different temperatures, the glucose level at 37 ºC was 1.0 (± 0.5) mmol/L (p<0.01), at 22 ºC 3.0 (± 0.6) mmol/L (p<0.01), and at 0 ºC 5.4 (± 0.7) mmol/L (p=0.95). The decline in glucose concentration seemed to be independent of addition of insulin and bacterial endotoxin. Endogenous insulin levels decreased from baseline 48 (36-94) pmol/L to 23 (18-27) pmol/L (p=0.03) during six hours incubation at 37 ºC. Conclusions: Glucose concentration was markedly reduced during in vitro incubation of whole blood from healthy volunteers for six hours at 37 ºC and 22 ºC, but was maintained at 0 ºC. Endogenous insulin level after six hours incubation of whole blood at 37 ºC was more than halved compared to baseline. During in vitro studies of glucose and/or insulin effects lasting for hours, measures must be undertaken to maintain stable glucose and/or insulin concentrations.

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“…This type of device might prove beneficial in a diabetic patient undergoing a long, complicated, or high-risk procedure in which frequent and accurate glucose monitoring is required. 40 As an alternative to blood sampling, subcutaneous sensors for continuous monitoring are available and have been found to correlate with BG values. These devices may not have the needed accuracy for routine use in an acute care setting such as with surgical patients.…”

Section: Diagnostic Proceduresmentioning

confidence: 99%

“…A preoperative hemoglobin A1c less than 7% confers good long-term glucose control and has been associated with decreased risk of infectious complications. 40 Continuous glucose monitoring devices can be used to obtain real-time BG analysis and allow for closer monitoring and for prevention of the deleterious effects associated with hypoglycemia. These devices can be quite accurate but require frequent calibration.…”

Section: Diagnostic Proceduresmentioning

confidence: 99%