Horm Metab Res 2017; 49(07): 527-533
DOI: 10.1055/s-0043-105501
Endocrine Care
© Georg Thieme Verlag KG Stuttgart · New York

Reactive Rather than Proactive Diabetes Management in the Perioperative Period

Inge Hommel
1   Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
,
Petra J. van Gurp
2   Department of General Internal Medicine, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
,
Alfons A. den Broeder
3   Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
,
Hub Wollersheim
1   Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
,
Femke Atsma
1   Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
,
Marlies E. J. L. Hulscher
1   Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
,
Cees J. Tack
2   Department of General Internal Medicine, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
› Author Affiliations
Further Information

Publication History

received 02 January 2017

accepted 01 March 2017

Publication Date:
24 April 2017 (online)

Abstract

As perioperative hyperglycemia is associated with poor postoperative patient outcomes, clinical guidelines provide recommendations for optimal perioperative glucose control. It is unclear to what extent recommended glucose levels are met in daily practice, and little is known about factors that influence these levels. We describe blood glucose levels throughout the hospital care pathway in 375 non-critically ill patients with diabetes who underwent major surgery (abdominal, cardiac, or orthopedic) in 6 hospitals, examine determinants of these levels including adherence to 9 quality indicators for optimal perioperative diabetes care, and perform qualitative interviews to identify barriers for optimal care. Virtually all patients (95%) experienced at least one hyperglycemic value (>10 mmol/l); 9% had at least one value <4 mmol/l. Mean glucose increased from preoperative to postoperative day (POD) 1 (+2.3 mmol/l, 5–95% CI 1.9–2.7), and then gradually decreased on POD 2–14 (+1.8 mmol/l, 5–95% CI 1.4–2.2). Insulin-treated patients (with or without oral agents) had higher glucose levels (+1.7 mmol/l, 5–95% CI 0.5–3.0, and +1.2 mmol/l, −0.1 to −2.5) than patients using oral agents only. Indicator adherence tended to be associated with higher glucose levels. Barriers for optimal care included a lack of formalized agreements on target glucose levels, absence of directly obvious disadvantages of hyperglycemia, and concern about inducing hypoglycemia. Hyperglycemia is common after major surgery, in particular on POD1 and in insulin-treated patients. Our results suggest that perioperative diabetes care is reactive rather than proactive, and that current emphasis of professionals is on treating instead of preventing postoperative hyperglycemia.

Supporting Information

 
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