Proactive protocol-based management of hyperglycemia and diabetes in colorectal surgery patients

Dorin T. Colibaseanu, Osayande Osagiede, Rozalina McCoy, Aaron Spaulding, Elizabeth B Habermann, James M Naessens, Michelle F. Perry, Launia J. White, Robert R. Cima

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective: The management of diabetic patients undergoing elective abdominal surgery continues to be unsystematic, despite evidence that standardized perioperative glycemic control is associated with fewer postoperative surgical complications. We examined the efficacy of a pre-operative diabetes optimization protocol implemented at a single institution in improving perioperative glycemic control with a target blood glucose of 80 to 180 mg/dL. Methods: Patients with established and newly diagnosed diabetes who underwent elective colorectal surgery were included. The control group comprised 103 patients from January 1, 2011, through December 31, 2013, before protocol implementation. The glycemic-optimized group included 96 patients following protocol implementation from January 1, 2014, through July 31, 2016. Data included demographic information, blood glucose levels, insulin doses, hypoglycemic events, and clinical outcomes (length of stay, re-admissions, complications, and mortality). Results: Patients enrolled in the glycemic optimization protocol had significantly lower glucose levels intra-operatively (145.0 mg/dL vs. 158.1 mg/dL; P = .03) and postoperatively (135.6 mg/dL vs. 145.2 mg/dL; P = .005). A higher proportion of patients enrolled in the protocol received insulin than patients in the control group (0.63 vs. 0.48; P = .01), but the insulin was administered less frequently (median [interquartile range] number of times, 6.0 [2.0 to 11.0] vs. 7.0 [5.0 to 11.0]; P = .04). Two episodes of symptomatic hypoglycemia occurred in the control group. There was no difference in clinical outcomes. Conclusion: Improved peri-operative glycemic control was observed following implementation of a standardized institutional protocol for managing diabetic patients undergoing elective colorectal surgery.

Original languageEnglish (US)
Pages (from-to)1073-1085
Number of pages13
JournalEndocrine Practice
Volume24
Issue number12
DOIs
StatePublished - Dec 1 2018

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Colorectal Surgery
Hyperglycemia
Insulin
Control Groups
Blood Glucose
Hypoglycemia
Hypoglycemic Agents
Length of Stay
Demography
Glucose
Mortality

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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Proactive protocol-based management of hyperglycemia and diabetes in colorectal surgery patients. / Colibaseanu, Dorin T.; Osagiede, Osayande; McCoy, Rozalina; Spaulding, Aaron; Habermann, Elizabeth B; Naessens, James M; Perry, Michelle F.; White, Launia J.; Cima, Robert R.

In: Endocrine Practice, Vol. 24, No. 12, 01.12.2018, p. 1073-1085.

Research output: Contribution to journalArticle

Colibaseanu, Dorin T. ; Osagiede, Osayande ; McCoy, Rozalina ; Spaulding, Aaron ; Habermann, Elizabeth B ; Naessens, James M ; Perry, Michelle F. ; White, Launia J. ; Cima, Robert R. / Proactive protocol-based management of hyperglycemia and diabetes in colorectal surgery patients. In: Endocrine Practice. 2018 ; Vol. 24, No. 12. pp. 1073-1085.
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AU - Osagiede, Osayande

AU - McCoy, Rozalina

AU - Spaulding, Aaron

AU - Habermann, Elizabeth B

AU - Naessens, James M

AU - Perry, Michelle F.

AU - White, Launia J.

AU - Cima, Robert R.

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N2 - Objective: The management of diabetic patients undergoing elective abdominal surgery continues to be unsystematic, despite evidence that standardized perioperative glycemic control is associated with fewer postoperative surgical complications. We examined the efficacy of a pre-operative diabetes optimization protocol implemented at a single institution in improving perioperative glycemic control with a target blood glucose of 80 to 180 mg/dL. Methods: Patients with established and newly diagnosed diabetes who underwent elective colorectal surgery were included. The control group comprised 103 patients from January 1, 2011, through December 31, 2013, before protocol implementation. The glycemic-optimized group included 96 patients following protocol implementation from January 1, 2014, through July 31, 2016. Data included demographic information, blood glucose levels, insulin doses, hypoglycemic events, and clinical outcomes (length of stay, re-admissions, complications, and mortality). Results: Patients enrolled in the glycemic optimization protocol had significantly lower glucose levels intra-operatively (145.0 mg/dL vs. 158.1 mg/dL; P = .03) and postoperatively (135.6 mg/dL vs. 145.2 mg/dL; P = .005). A higher proportion of patients enrolled in the protocol received insulin than patients in the control group (0.63 vs. 0.48; P = .01), but the insulin was administered less frequently (median [interquartile range] number of times, 6.0 [2.0 to 11.0] vs. 7.0 [5.0 to 11.0]; P = .04). Two episodes of symptomatic hypoglycemia occurred in the control group. There was no difference in clinical outcomes. Conclusion: Improved peri-operative glycemic control was observed following implementation of a standardized institutional protocol for managing diabetic patients undergoing elective colorectal surgery.

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