Preoperative glucose as a screening tool in patients without diabetes

Wang, Rui; Panizales, Maria Theresa P.; Hudson, Margo; Rogers, Selwyn O.; Schnipper, Jeffrey L.

doi:10.1016/j.jss.2013.09.014

Cited by 27 publications

(25 citation statements)

References 35 publications

(38 reference statements)

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“…Given that 40% of these women had hemoglobin A1c testing showing they were not diabetic perioperatively, it is more likely that these 30 women have insulin resistance, possible pre-diabetes, and have a significant risk of developing diabetes in the future. In a study by Wang et al at Brigham and Women’s Hospital with a similar study population, among patients without known diabetes and with a fasting preoperative glucose ≥100 mg/dL, 15% were diagnosed with diabetes within 1 year of surgery 17. Thus, although it appears women with elevated preoperative glucose values ≥180 mg/dL after receiving a carbohydrate load are unlikely to develop a perioperative complication, nonetheless they should likely be flagged for risk of developing diabetes in the future after surgery.…”

Section: Discussionmentioning

confidence: 99%

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Perioperative glycemic measures among non-fasting gynecologic oncology patients receiving carbohydrate loading in an enhanced recovery after surgery (ERAS) protocol

Alimena

Falzone

Feltmate

et al. 2020

Int J Gynecol Cancer

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IntroductionPreoperative carbohydrate loading is an effective method to control postoperative insulin resistance. However, data are limited concerning the effects of carbohydrate loading on preoperative hyperglycemia and possible impacts on complication rates.MethodsA prospective cohort study was performed of patients enrolled in an enhanced recovery after surgery pathway at a single institution. All patients underwent laparotomy for known or suspected gynecologic malignancies. Patients who had been diagnosed with diabetes preoperatively and those prescribed total parenteral nutrition by their providers were excluded. Data regarding preoperative carbohydrate loading with a commercial maltodextrin beverage, preoperative glucose testing, postoperative day 1 glucose, insulin administration, and complications (all complications, infectious complications, and hyperglycemia-related complications) were collected. The primary endpoint of the study was the incidence of postoperative infectious complications, defined as superficial or deep wound infection, organ/space infection, urinary tract infection, pneumonia, sepsis, or septic shock.ResultsOf 415 patients, 76.9% had a preoperative glucose recorded. The mean age was 60.5±12.4 years (range 18–93). Of those with recorded glucose values, 30 patients (9.4%) had glucose ≥180 mg/dL, none of whom were actually given insulin preoperatively. Median preoperative glucose value was significantly increased after carbohydrate loading (122.0 mg/dL with carbohydrate loading vs 101.0 mg/dL without, U=3143, p=0.001); however, there was no relationship between carbohydrate loading and complications. There was a significantly increased risk of hyperglycemia-related complications with postoperative day 1 morning glucose values ≥140 mg/dL (OR 1.85, 95% CI 1.07 to 3.23; p=0.03). Otherwise, preoperative and postoperative hyperglycemia with glucose thresholds of ≥140 mg/dL or ≥180 mg/dL were not associated with increased risk of other types of complications.DiscussionCarbohydrate loading is associated with increased preoperative glucose values; however, this is not likely to be clinically significant as it does not have an impact on complication rates. Preoperative hyperglycemia is not a risk factor for postoperative complications in a carbohydrate-loaded population when known diabetic patients are excluded.PrecisWhile glucose increased with carbohydrate loading in non-diabetic patients, this was not associated with complications.

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Section: Discussionmentioning

confidence: 99%

“…Hyperglycemia was defined as glucose ≥140 mg/dL 17. Per the established protocol at our institution, insulin is indicated in diabetic patients for preoperative glucose ≥180 mg/dL, as that has been reported as the inflection point for increased risk of surgical site infections 18.…”

Section: Methodsmentioning

confidence: 99%

Perioperative glycemic measures among non-fasting gynecologic oncology patients receiving carbohydrate loading in an enhanced recovery after surgery (ERAS) protocol

Alimena

Falzone

Feltmate

et al. 2020

Int J Gynecol Cancer

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show abstract

“…Even with evidence to provide glucose control, compliance among anesthesia professionals is poor, possibly because of fear of a hypoglycemic effect . Many of the studies supported the need for perioperative glucose monitoring, and additional studies showed a correlation between random elevated blood glucose readings and postoperative complications . Perioperative nurses and leaders continue to struggle with the question of how to encourage compliance with blood glucose monitoring and initiation of treatment when the evidence shows that the risk of adverse outcomes is significant for both diabetic and nondiabetic populations.…”

Section: Discussionmentioning

confidence: 99%

“…Hyperglycemia is strongly correlated with increased mortality and morbidity in patients undergoing surgery . In addition, undiagnosed insulin resistance is progressively more common on the day of surgery .…”

mentioning

confidence: 99%

Perioperative Hyperglycemia: A Literature Review

Peacock¹

2018

AORN Journal

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The purpose of this literature review is to examine current evidence and determine the effects of stress hyperglycemia on patient outcomes during the perioperative period. This review summarizes the pathophysiology of stress hyperglycemia, the population it affects, and strategies for optimal treatment to reduce the potential for postoperative complications. A literature search produced 16 of the most current studies on the effect of stress hyperglycemia in both the diabetic and nondiabetic populations. The evidence presented indicates the need to maintain tight glucose control in the perioperative patient. Although there are varying approaches to managing stress hyperglycemia, there is compelling agreement that stress hyperglycemia should be treated in all surgical patients.

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“…Таким образом, для обеспе-чения наилучшего качества периоперационного ведения больных ишемической болезнью сердца (ИБС) с СД жизненно необходим адекватный гликемический кон-троль [4]. Определение уровня глюкозы в крови является рутинным исследованием, проводимым у большинства больных, находящихся в отделении интенсивной тера-пии и реанимации (ОРИТ).…”

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Comparative analisis of the dynamics of glycemia using continuos glucose monitoring during on-pump or off-pump coronary artery bypass grafting

Golukhova¹,

Магомедова²,

Чеботарева³

2016

Diabetes mellitus

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Сравнительный анализ динамики гликемии при операциях реваскуляризации миокарда в условиях искусственного кровообращения и на работающем сердце с использованием систем непрерывного мониторирования глюкозы Голухова Е.З., Магомедова Н.М., Чеботарева Г.Е. ФГБУ Научный центр сердечно-сосудистой хирургии им. А.Н. Бакулева, Москва

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Preoperative glucose as a screening tool in patients without diabetes

Cited by 27 publications

References 35 publications

Perioperative glycemic measures among non-fasting gynecologic oncology patients receiving carbohydrate loading in an enhanced recovery after surgery (ERAS) protocol

Perioperative glycemic measures among non-fasting gynecologic oncology patients receiving carbohydrate loading in an enhanced recovery after surgery (ERAS) protocol

Perioperative Hyperglycemia: A Literature Review

Comparative analisis of the dynamics of glycemia using continuos glucose monitoring during on-pump or off-pump coronary artery bypass grafting

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