Standardized Glycemic Management versus Conventional Glycemic Management and Postoperative Outcomes in Type 2 Diabetes Patients Undergoing Elective Surgery

Nuttawut Vongsumran, Supawan Buranapin, Worapaka Manosroi Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, ThailandCorrespondence: Worapaka Manosroi Tel +66 53 936453Email worapaka.m@gmail.comPurpose: Optimized postoperative bl...

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Autores principales:	Vongsumran N, Buranapin S, Manosroi W
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	diabetes mellitus perioperative management blood glucose control protocol postoperative complications Specialties of internal medicine RC581-951
Acceso en línea:	https://doaj.org/article/86f74deccb6e43c3b4d0d12fa7f6bc0c
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spelling	oai:doaj.org-article:86f74deccb6e43c3b4d0d12fa7f6bc0c2021-12-02T10:43:35ZStandardized Glycemic Management versus Conventional Glycemic Management and Postoperative Outcomes in Type 2 Diabetes Patients Undergoing Elective Surgery1178-7007https://doaj.org/article/86f74deccb6e43c3b4d0d12fa7f6bc0c2020-07-01T00:00:00Zhttps://www.dovepress.com/standardized-glycemic-management-versus-conventional-glycemic-manageme-peer-reviewed-article-DMSOhttps://doaj.org/toc/1178-7007Nuttawut Vongsumran, Supawan Buranapin, Worapaka Manosroi Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, ThailandCorrespondence: Worapaka Manosroi Tel +66 53 936453Email worapaka.m@gmail.comPurpose: Optimized postoperative blood glucose control can minimize postoperative complications. Conventional perioperative glycemic control protocol (CG), which has been routinely used in our institution, lacks detailed perioperative glycemic management. A new standardized glycemic control protocol (SG) was designed which employs frequent postoperative monitoring of blood glucose, more tightly targeted blood glucose control, and adjustment of insulin dosage prior to surgery. This study compared the efficacy of postoperative glycemic control and complications with the two protocols, CG and SG.Patients and Methods: Three hundred and eighty type 2 diabetes patients who underwent elective surgeries were included in the study. Of those, 182 patients with CG were identified retrospectively as a historical control cohort. Additional 198 patients with SG were prospectively enrolled. Covariate imbalance was controlled using propensity score matching. Outcomes were evaluated using regression analysis clustered by type of surgery.Results: The SG group had lower mean levels of postoperative 24-hr blood glucose than the CG group (β =− 8.6 mg/dL; 95% CI (− 16.5 to − 7.9), p=0.042). In SG group, the incidence of ICU admission and of acute kidney injury after surgery was lower than in the CG group (OR 0.36; 95% CI (0.18– 0.74), p=0.005 and OR=0.59; 95% CI (0.41– 0.85), p=0.005, respectively). There was no significant difference in postoperative hypoglycemia, infection, cardiovascular complications, stroke, or mortality rate between the two groups.Conclusion: For type 2 diabetes patients undergoing elective surgery, the SG protocol is more effective in controlling blood glucose. The protocol can also reduce the incidence of some postoperative complications compared to CG with no increased risk of hypoglycemia.Keywords: diabetes mellitus, perioperative management, blood glucose control protocol, postoperative complicationsVongsumran NBuranapin SManosroi WDove Medical Pressarticlediabetes mellitusperioperative managementblood glucose control protocolpostoperative complicationsSpecialties of internal medicineRC581-951ENDiabetes, Metabolic Syndrome and Obesity: Targets and Therapy, Vol Volume 13, Pp 2593-2601 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	diabetes mellitus perioperative management blood glucose control protocol postoperative complications Specialties of internal medicine RC581-951
spellingShingle	diabetes mellitus perioperative management blood glucose control protocol postoperative complications Specialties of internal medicine RC581-951 Vongsumran N Buranapin S Manosroi W Standardized Glycemic Management versus Conventional Glycemic Management and Postoperative Outcomes in Type 2 Diabetes Patients Undergoing Elective Surgery
description	Nuttawut Vongsumran, Supawan Buranapin, Worapaka Manosroi Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, ThailandCorrespondence: Worapaka Manosroi Tel +66 53 936453Email worapaka.m@gmail.comPurpose: Optimized postoperative blood glucose control can minimize postoperative complications. Conventional perioperative glycemic control protocol (CG), which has been routinely used in our institution, lacks detailed perioperative glycemic management. A new standardized glycemic control protocol (SG) was designed which employs frequent postoperative monitoring of blood glucose, more tightly targeted blood glucose control, and adjustment of insulin dosage prior to surgery. This study compared the efficacy of postoperative glycemic control and complications with the two protocols, CG and SG.Patients and Methods: Three hundred and eighty type 2 diabetes patients who underwent elective surgeries were included in the study. Of those, 182 patients with CG were identified retrospectively as a historical control cohort. Additional 198 patients with SG were prospectively enrolled. Covariate imbalance was controlled using propensity score matching. Outcomes were evaluated using regression analysis clustered by type of surgery.Results: The SG group had lower mean levels of postoperative 24-hr blood glucose than the CG group (β =− 8.6 mg/dL; 95% CI (− 16.5 to − 7.9), p=0.042). In SG group, the incidence of ICU admission and of acute kidney injury after surgery was lower than in the CG group (OR 0.36; 95% CI (0.18– 0.74), p=0.005 and OR=0.59; 95% CI (0.41– 0.85), p=0.005, respectively). There was no significant difference in postoperative hypoglycemia, infection, cardiovascular complications, stroke, or mortality rate between the two groups.Conclusion: For type 2 diabetes patients undergoing elective surgery, the SG protocol is more effective in controlling blood glucose. The protocol can also reduce the incidence of some postoperative complications compared to CG with no increased risk of hypoglycemia.Keywords: diabetes mellitus, perioperative management, blood glucose control protocol, postoperative complications
format	article
author	Vongsumran N Buranapin S Manosroi W
author_facet	Vongsumran N Buranapin S Manosroi W
author_sort	Vongsumran N
title	Standardized Glycemic Management versus Conventional Glycemic Management and Postoperative Outcomes in Type 2 Diabetes Patients Undergoing Elective Surgery
title_short	Standardized Glycemic Management versus Conventional Glycemic Management and Postoperative Outcomes in Type 2 Diabetes Patients Undergoing Elective Surgery
title_full	Standardized Glycemic Management versus Conventional Glycemic Management and Postoperative Outcomes in Type 2 Diabetes Patients Undergoing Elective Surgery
title_fullStr	Standardized Glycemic Management versus Conventional Glycemic Management and Postoperative Outcomes in Type 2 Diabetes Patients Undergoing Elective Surgery
title_full_unstemmed	Standardized Glycemic Management versus Conventional Glycemic Management and Postoperative Outcomes in Type 2 Diabetes Patients Undergoing Elective Surgery
title_sort	standardized glycemic management versus conventional glycemic management and postoperative outcomes in type 2 diabetes patients undergoing elective surgery
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/86f74deccb6e43c3b4d0d12fa7f6bc0c
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Standardized Glycemic Management versus Conventional Glycemic Management and Postoperative Outcomes in Type 2 Diabetes Patients Undergoing Elective Surgery

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