Garg R, et al. - Researchers investigated if preoperative diabetes management can improve glycemic control and clinical outcomes after elective surgery. Preoperative and inpatient diabetes management was observed enhancing glycemic control on the day of surgery and postoperatively and decreasing the incidence of hypoglycemia. An eventual improvement in clinical outcomes with these changes could be expected. Although statistically marked, the decrease in Length of hospital stay (LOS) was of equivocal clinical significance in this study.

Methods

• Researchers identified patients with diabetes and treated them proactively before their scheduled surgeries.
• They collected data for all elective surgeries over 2 years before and 2 years after implementation of the program.

Results

• Researchers identified 31,392 patients undergoing first surgery.
• Of these, 3,909 had diabetes; 2,072 before and 1,835 after the program.
• On the day of surgery, mean blood glucose was 146.4 ± 51.9 mg/dL before and 139.9 ± 45.6 mg/dL after the program (P=0.0028).
• An increase in proportion of patients seen by the inpatient diabetes team was noted.
• During hospital stay, mean blood glucose was 166.7 ± 42.9 mg/dL before and 158.3 ± 46.6 mg/dL after program (P < 0.0001).
• Hypoglycemic episodes (<50 mg/dL) were reported in 4.93% patients before and 2.48% patients after the program (P < 0.0001).
• Patients with diabetes showed decreased length of LOS (4.8 ± 5.3 to 4.6 ± 4.3 days; P = 0.01) and it remained unchanged among patients without diabetes (4.0 ± 4.5 and 4.1 ± 4.8, respectively; P = 0.42).
• Diabetic and nondiabetic groups were similar in terms of changes in intravenous antibiotic use, patients discharged to home, renal insufficiency, myocardial infarction, stroke, and in-hospital mortality.