Use of a Glucose Management Service Improves Glycemic Control Following Vascular Surgery: An Interrupted Time-Series Study

Abstract

Article-at-a-Glance Background The optimal method for obtaining good blood glucose control in noncritically ill patients undergoing peripheral vascular surgery remains a topic of debate for surgeons, endocrinologists, and others involved in the care of patients with peripheral arterial disease and diabetes. A prospective trial was performed to evaluate the impact of routine use of a glucose management service (GMS) on glycemic control within 24 hours of lower-extremity revascularization (LER). Methods In an interrupted time-series design (May 1, 2011–April 30, 2012), surgeon-directed diabetic care (Baseline phase) to routine GMS involvement (Intervention phase) was compared following LER. GMS assumed responsibility for glucose management through discharge. The main outcome measure was glycemic control, assessed by (1) mean hospitalization glucose and (2) the percentage of recorded glucose values within target range. Statistical process control charts were used to assess the impact of the intervention. Results Clinically important differences in patient demographics were noted between groups; the 19 patients in the Intervention arm had worse peripheral vascular disease than the 19 patients in the Baseline arm (74% critical limb ischemia versus 58%; p = .63). Routine use of GMS significantly reduced mean hospitalization glucose (191 mg/dL Baseline versus 150 mg/dL Intervention, p < .001). Further, the proportion of glucose values in target range increased (48% Baseline versus 78% Intervention, p = .05). Following removal of GMS involvement, measures of glycemic control did not significantly decrease for the 19 postintervention patients. Conclusions Routine involvement of GMS improved glycemic control in patients undergoing LER. Future work is needed to examine the impact of improved glycemic control on clinical outcomes following LER.

Glucose management team significantly improves glycaemic care and commitment to in‐hospital guidelines within arthroplastic patients

“…Previous studies have shown promising results on in-hospital glucose management teams [13][14][15][18][19][20][21][22] : Retrospective analyses suggest that they improve access to care and glycaemic control but reduce readmissions and duration of the inpatient period 13,15,[18][19][20] and of costs. 21 Prospective studies are few: Wallaert and co-writers studied 38 surgical patients with vascular disease and showed that the involvement of a glucose management team improves glycaemic care.…”

“…21 Prospective studies are few: Wallaert and co-writers studied 38 surgical patients with vascular disease and showed that the involvement of a glucose management team improves glycaemic care. 22 Gardiner and colleagues proved that GMT reduces blood glucose and HbA1c levels. 14 These studies did not include patients with no diabetes.…”