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. 2023 May;17(3):679-682.
doi: 10.1177/19322968231168904. Epub 2023 Apr 16.

Perioperative Insulin Regimens in Patients With Insulin-Treated Type 2 Diabetes Mellitus Hospitalized for a Short Time for Minor Eye Surgery

Sandra Pfleger  1 , Renald Meçani  2 , Barbara Semlitsch  2 , Anja Krall  2 , Gerald Sendlhofer  3   4 , Julia K Mader  2 , Andreas Wedrich  1
Affiliations

Perioperative Insulin Regimens in Patients With Insulin-Treated Type 2 Diabetes Mellitus Hospitalized for a Short Time for Minor Eye Surgery

Sandra Pfleger et al. J Diabetes Sci Technol. 2023 May.

Abstract

Background: Elective surgery in patients with insulin-treated type 2 diabetes mellitus (T2D) and the admission period in the hospital, comprise a distinctive and challenging situation for physicians, nurses, as well as for the patients themselves. There is a lack of widely accepted evidence-based and standardized approach of care in regard to perioperative management of patients with insulin-treated T2D.

Methods: The main purpose of this proof-of-concept study was to investigate whether a standardized insulin and meal regimen on the day of surgery leads to a better management of diabetes in terms of blood glucose (BG) levels. Two different insulin and meal regimens-group A with half of insulin dose given with a standardized postoperative meal and group B with a custom preoperative breakfast and full insulin dose-were compared with Group C with routine care (no meal and no insulin injection on the day of surgery). Each group consisted of 12 to 15 patients. BG measurements were performed pre- and immediately postoperatively, before meals and at bedtime.

Results: Both standardized and well-defined insulin and meal regimens resulted in better average BG levels in the perioperative period, especially in the morning after the surgery.

Conclusions: In this study, we observed that a standardized perioperative insulin regimen efficiently lowered postoperative BG levels. Providing a custom breakfast and a full insulin dose resulted in lower postoperative BG levels. These approaches were not associated with an increase in hypoglycemic events. Physicians and nursing staff gave positive feedback to the structured and well-defined approaches.

Keywords: hyperglycemia; hypoglycemia; insulin regimen; insulin-treated type 2 diabetes; minor surgery; perioperative.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: JKM is a member on the advisory board of Becton-Dickinson, Eli Lilly, embecta, Medtronic, NovoNordisk, Pharmasens AG, Roche Diabetes Care, and Sanofi-Aventis and received speaker honoraria from Abbott Diabetes Care, A. Menarini Diagnostics, Becton-Dickinson, Dexcom, Eli Lilly, Medtrust AG, NovoNordisk, Roche Diabetes Care, Sanofi-Aventis, Servier, and Ypsomed. BS received speaker honoraria from NovoNordisk. The other authors do not have a conflict of interest to declare.

Figures

Figure 1.
Figure 1.
Glucose levels of the three groups (BG, blood glucose levels; Group A, postoperative meal and half insulin dose; Group B, custom breakfast and full insulin dose; Group C, routine care) throughout hospitalization. Data are indicated as mean ± standard error of the mean.
See this image and copyright information in PMC

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