Article thumbnail

Creating a Perioperative Glycemic Control Program

By Sara M. Alexanian, Marie E. McDonnell and Shamsuddin Akhtar

Abstract

Hyperglycemia in the surgical population is a recognized risk factor for postoperative complications; however, there is little literature to date regarding the management of hyperglycemia in the perioperative period. Here, we detail the strategies that our institutions have employed to identify and treat hyperglycemia in patients with diabetes who present for surgery. Our approach focuses on the recognition of hyperglycemia and metabolic abnormalities, control of glucose levels via insulin infusion when needed, monitoring for hypoglycemia and a comprehensive multidisciplinary approach that provides standardized recommendations for patients at all points in care as they transition from the preoperative clinic into the operating room, and then into the hospital

Topics: Review Article
Publisher: Hindawi Publishing Corporation
OAI identifier: oai:pubmedcentral.nih.gov:3168770
Provided by: PubMed Central

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.

Suggested articles

Citations

  1. (2008). A simulation model of glucose regulation in the critically ill,”
  2. (2011). A.Qaseem,L.L.H umphrey ,R.Chou,V .Snow ,andP .Shek elle, “Use of intensive insulin therapy for the management of glycemic control in hospitalized patients: a clinical practice guideline from the American College of Physicians,”
  3. (2005). and M.Carlsson,“Peri-operativeglucosecontrolanddevelopment of surgical wound infections in patients undergoing coronary artery bypass graft,” J o u rn a lo fH o s p i t a lI n fe cti o n ,v o l .6 1 ,n o .3 ,
  4. (2005). Association between hyper- and hypoglycaemia and 2 year all-cause mortality risk in diabetic patients with acutecoronaryevents,”EuropeanHeartJournal,vol.26,no.13,
  5. (2008). Association between intraoperative and early postoperative glucose levels and adverse outcomesaftercomplex congenital heart surgery,”
  6. (2008). Benefits and risks of tight glucose control in critically ill adults: a metaanalysis,”
  7. (2009). Comparison of three protocols for tight glycemic control in cardiac surgery patients,” Diabetes Care,
  8. (2010). Comparisons of different insulin infusion protocols: a review of recent literature,”CurrentOpinioninClinicalNutritionandMetabolic Care,
  9. (2009). Continuous perioperative insulin infusion decreases major cardiovascular events in patients undergoing vascular surgery: a prospective, randomized trial,”
  10. (2004). Early post-operative glucose levels are an independent risk factor for infection after peripheral vascular surgery. A retrospective study,”
  11. (1998). Early postoperativeglucosecontrolpredictsnosocomialinfectionratein diabetic patients,”
  12. (2010). Editorial: how sweet it is ...
  13. (2004). Effect of an intensive glucose management protocol on the mortality of critically Ill adult patients,”
  14. (2008). Effects of intensive glucose lowering in type 2 diabetes,” The New England
  15. (2006). Evaluation of short-term consequences of hypoglycemia in an intensive care unit,”
  16. (2009). focused updates:ACC/AHAguidelinesforthemanagementofpatients with st-elevation myocardial infarction (Updating the 2004 guideline and
  17. (2011). G.E.Umpierrez,D.Smiley,S.Jacobsetal.,“Randomizedstudy of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes undergoing general surgery
  18. (2009). G.E.Umpierrez,T.Hor,D.Smileyetal.,“Comparisonofinpatient insulin regimens with detemir plus aspart Versus neutral protaminehagedornplusregularinmedicalpatientswithtype 2 diabetes,”
  19. (2010). Glucose measurement in the operating room: more complicated than it seems,”
  20. (2010). Glycemic control and infections in patients with diabetes undergoing noncardiac surgery,”
  21. (2010). Glycemic control in the ICU,” The New England
  22. (2010). Glycemic control in the peri-operative setting: results of a 3 month pilot program at an academic institution,”
  23. (2009). Guidelines forpreoperative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery,”
  24. (2010). Hypoglycemia and outcome in critically ill patients,”
  25. (2007). Implementing an intravenous insulin infusion protocol in the intensive care unit,”
  26. (2007). Increased preoperative glucose levels are associated with perioperative mortalityinpatientsundergoingnoncardiac,nonvascularsurgery,”
  27. (2006). Inpatient management of hyperglycemia: the northwestern experience,”
  28. (2009). Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data,”
  29. (2011). Intensive insulin therapy in hospitalized patients: a systematic review,”
  30. (2007). Intensive intraoperative insulin therapy versus conventional glucose managementduringcardiacsurgery:arandomizedtrial,”Annalsof
  31. (2009). Intensive versus conventional glucose control in critically Ill patients,”
  32. (2005). Intraoperative hyperglycemia and perioperative outcomes in cardiac surgery patients,”
  33. (2005). K u ,C .A .S a y r e ,I .B .H i r s c h ,a n dJ .L .K e l l y ,“ N e w insulin infusion protocol Improves blood glucose control in hospitalized patients without increasing hypoglycemia,”
  34. (2009). M o g h i s s i ,M .T .K o r y t k o w s k i ,M .D i N a r d oe ta l . ,“ A m e r -ican Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control,”DiabetesCare,vol.32,no.6,pp.1119–1131,
  35. (2006). Management of hyperglycemia
  36. (2010). Management of hyperglycemia in hospitalized patients,”
  37. (2010). Oudemans-van Straaten et al., “Mean glucose during ICU admission is related to mortality by a U-shaped curve in surgical and medical patients: a retrospective cohort study,”
  38. (2010). Prevalence and clinical outcome of hyperglycemia in the perioperative period in noncardiac surgery,”
  39. (2008). R.P.Dellinger,M.M.Levy,J.M.Carletetal.,“Survivingsepsis campaign: international guidelines for management of severe sepsis and septic shock:
  40. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2
  41. (2009). Relationship between spontaneous and iatrogenic hypoglycemia and mortality in patients hospitalized with acute myocardial infarction,”
  42. (2005). Reliability of point-of-care testingforglucosemeasurementincriticallyilladults,”Critical
  43. (2010). Scientific principles and clinical implications of perioperative glucose regulation and control,”
  44. (2007). Soo Hoo, “Intensive insulin therapy in critical care: a review of 12 protocols,”
  45. (2007). Thiyagarajan et al., “Reduction of surgical mortality and morbidity in diabetic patients undergoing cardiac surgery with a combined intravenous and subcutaneous insulin glucose management strategy,” Diabetes Care,
  46. (2010). Toward understanding tight glycemic control in the ICU: a systematic review and metaanalysis,”
  47. (2009). Treatment options for safely achieving glycemic targets in the hospital,” in Revisiting Inpatient Hyperglycemia New Recommendations, Evolving Data,
  48. (2007). u n g a n ,J .C h a p m a n ,S .S .B r a i t h w a i t e ,a n dJ .B u s e ,“ G l u -cose measurement: confounding issues in setting targets for inpatient management,” Diabetes Care,
  49. (2005). U-shaped relationship of blood glucose with adverse outcomes among patientswithST-segmentelevationmyocardialinfarction[1],”