A. W. Harrington1, J. Dohlman3, R. Assi1, S. A. Weinzimer2 1Yale New Haven Hospital,Department Of Surgery,New Haven, CT, USA 2Yale New Haven Hospital,Department Of Pediatrics,New Haven, CT, USA 3Yale University School Of Medicine,New Haven, CT, USA
Introduction: The aim of this study was to evaluate the methods and quality of perioperative blood sugar control in general surgical patients with insulin dependent diabetes, at a tertiary, academic hospital center, as well as to identify specific areas for improvement in management of perioperative hyperglycemia.
Methods: This was a retrospective chart review of all patients with a documented diagnosis of insulin dependent diabetes, who underwent an inpatient surgical procedure within a one year period from 2013 to 2014. Patients were included only if they had an A1C within three months of the surgical procedure and had at least 48 hours of blood sugar data postoperatively.
Results: There was a strong correlation between patients’ baseline glycemic control, as established by a documented A1C within three months of the surgical procedure, and their perioperative glycemic control, as demonstrated by a calculated perioperative A1C (p<0.0001). There was also no statistical difference in glycemic control between the first and second postoperative day. Our current protocols maintain patients’ baseline control in the perioperative period, despite increased stress of surgery and changes in diet. However, the average preoperative A1C was 8.5%, and 29 patients (74%) had an A1C above 7.0%.
Conclusion: The majority of insulin dependent patients undergoing general surgery had poor preoperative glycemic control. Current glycemic control protocols maintained perioperative glycemia in the same preoperative range, and successfully prevented worsening of hyperglycemia. Therefore, we propose that an average blood sugar greater than 155 mg/dL (corresponding to an A1C of 7%) on postoperative day one trigger a consult by a virtual endocrinology team for both inpatient and outpatient adjustments to insulin dosing. The results of our study also highlight opportunities to educate patients and provide interventions to improve both pre and postoperative glucose control.