Management of diabetes during surgery. A retrospective study of 112 cases.
In a retrospective study, glycaemic control on the day of surgery in 68 diabetic patients, managed by a diabetes team (group A), was compared with that in 44 managed by the surgeon and/or anaesthetist alone (group B). Group A insulin dependent patients and NIDDM undergoing major operations were treated by glucose-insulin-potassium infusion (16 units rapid-acting insulin + 10 mmol potassium chloride/500 ml 10% dextrose at 100 ml/h) modified according to blood glucose values (59 cases); well controlled NIDDM undergoing minor operations received no specific therapy (9 cases). Group B patients were treated by a wide variety of regimens. Blood glucose was measured on average 5 times on the operative day in team-managed patients and only twice in the other patients. One-third of the latter group had no glucose measurements at all. Blood glucose values were lower in team-managed patients. Adequate diabetic control, defined as mean blood glucose on the operation day below 216 mg/dl, without hypoglycaemia, was obtained in 82% of team patients but only in 58% of non-team patients. Control was particularly poor in NIDDM under-going major operations and not treated with GIK. Mortality and morbidity were similar in the two groups. We conclude that better glycaemic control was obtained in patients managed by a diabetic team using a glucose insulin potassium infusion. This approach is suitable for any general hospital which offers a diabetic service.
D001786:Blood Glucose / Q000032:analysis; D003920:Diabetes Mellitus / Q000628:therapy; D005947:Glucose / Q000627:therapeutic use; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D008875:Middle Aged; D010348:Patient Care Team; D011183:Postoperative Complications / Q000517:prevention & control; D011188:Potassium / Q000627:therapeutic use; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative
D001786:Blood Glucose; D007328:Insulin; D005947:Glucose; D011188:Potassium