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

Abstract

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.

Continuous subcutaneous insulin infusion reduces the risk of postoperative infection

“…Several studies have shown that the use of CSII during the perioperative period is safe and effective; it led to better glucose control, shorter anesthesia time, and a lower proportion of general anesthesia recipients. 31,37,38 It is interesting to note that the CSII group had less glucose fluctuation as compared with the MDI group. Several reasons account for this difference.…”

“…[5][6][7][8][9][10] Furthermore, there is evidence supporting that perioperative hyperglycemia is also associated with a higher rate of hospital complications and mortality. 3,4,13,42 Since our previous work showed the advantage of CSII in perioperative glucose management, 31 it was intriguing to know whether CSII also has positive effects in reducing infection and improving postoperative outcomes. In order to answer this question, the present study collected more cases and had a larger sample size (253 pairs of patients) for a more detailed new analysis.…”

“…[27][28][29][30] Our previous study showed that CSII improved hyperglycemia in perioperative patients. 31 However, it is important to investigate whether improvement of hyperglycemia leads to reduction of surgery-related complications in perioperative patients. Therefore, we retrospectively inspected the medical records of diabetic patients who underwent surgery in our hospital during the last decade and analyzed various short-term outcomes related to operations in patients with either CSII therapy or non-CSII therapy and determined whether the use of CSII could provide better prognosis and improve postoperative life quality of patients.…”

Preoperative Glycemic Control for Adult Diabetic Patients Undergoing Elective Surgery

“…One study found insulin pump use in the perioperative setting had no increased medical expenditures and had similar patient outcomes as standard insulin injections [30]. Some protocols recommend reducing the basal insulin by 20% at midnight before surgery when using an insulin pump, but no consensus has been agreed upon [20].…”

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

“…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.…”