Perioperative Hyperglycemia and Glucose Variability in Gynecologic Laparotomies

Abstract

Gynecologic laparotomies can be classified as major abdominal surgery and carry a substantial risk of postoperative morbidity. 1 However, the glycemic response to major gynecologic surgery is not known, contrary to many other types of surgery. 2-5 In the perioperative period, plasma glucose can increase due to surgical stress, so-called stress hyperglycemia. 6 The occurrence of stress hyperglycemia is related to excessive production of cortisol and catecholamine's, leading to increased gluconeogenesis and peripheral insulin resistance. 6 This might contribute to complications like an increased risk of wound infection, activation of coagulation and longer hospital stay, 3,5,7 although not in all surgical populations. 8 In addition to the type of surgery, several patient characteristics, such as increased age and a higher body mass index, put this patient population at risk for the development of perioperative hyperglycemia. 9 Retrospective studies have suggested that increased perioperative glucose variability in combination with hyperglycemia is more detrimental than hyperglycemia alone, 3,10-13 and glucose variability is associated with an higher risk of mortality in critically ill patients. 11,12 However, all studies on glucose variability are retrospective in nature, with significant bias due to the number of glucose measurements performed. Until now, no prospective studies have described the role of glucose variability in the perioperative period. Only when the glycemic response and glucose variability during gynecologic laparotomies are known, can their relevance in the perioperative setting of gynecologic laparotomies be assessed. We therefore prospectively investigated the 595985D STXXX10.

Peri‐operative management of patients with type‐2 diabetes mellitus undergoing non‐cardiac surgery using liraglutide, glucose–insulin–potassium infusion or intravenous insulin bolus regimens: a randomised controlled trial

“…In the peri‐operative period, glucose peaks in the first hour after surgery and is, therefore, a good measure of overall peri‐operative glucose control . Preventing this peak is likely to facilitate glucose management postoperatively.…”

Peri‐operative continuation of metformin does not improve glycaemic control in patients with type 2 diabetes: A randomized controlled trial

“…The primary outcome was the between‐group difference in mean glucose concentration 2 hours postoperatively, when glucose concentrations reach their maximum after surgery …”

“…The primary outcome was the between-group difference in mean glucose concentration 2 hours postoperatively, when glucose concentrations reach their maximum after surgery. 9,10 Secondary outcomes were the difference in fasting glucose levels before and 1 day after surgery, lactate levels before, 2 hours and 1 day after surgery, amount of insulin administered during surgery, occurrence of mild (<4.0 mmol/L) and severe hypoglycaemia (<2.3 mmol/L), length of hospital stay and number of complications within 30 days after surgery.…”

Systematic review of incretin therapy during peri-operative and intensive care

“…Usual management of hyperglycaemia in these settings primarily involves intravenous infusions of insulin, with the dose titrated according to intermittent measurement of blood glucose [ 4 ]. This strategy is somewhat complicated and labour–intensive, and it increases the risk of hypoglycaemia and glycaemic variability, which are both associated with adverse outcome [ 3 , 5 – 10 ].…”