Perioperative diabetes regulation with the help of a standard protocol.
According to a standard protocol 115 patients (96 type 2 DM, 19 type 1 DM) were treated with a 3 litre glucose 5%/day infusion, KCl and insulin, with the aim of obtaining near-normoglycaemia perioperatively. Blood glucoses of 6.7-10.0 mmol/l were scored as ideal, 3.5-15.0 mmol/l as acceptable, and the remaining values as unacceptable. In 32 patients (28%) the protocol was followed in all aspects, whereas in 45 patients (39%) the protocol was followed in therapeutic aspects (total n = 77.67%, Group 1). In the remaining 38 patients (33%) protocol violations occurred (Group 2). In 48 patients (62%) of Group 1 ideal or acceptable control was obtained perioperatively versus 11 patients (29%) of Group 2 (p < 0.05). In patients with good preoperative long-term regulation (HbA1 < or = 8.0%; n = 81) ideal or acceptable perioperative control was achieved in 58% (n = 47) versus 13% (n = 4) of those (n = 31) with preoperative HbA1 > 8.0% (p < 0.05). Stepwise multiple logistic regression analysis showed that preoperative long-term regulation (HbA1; p < 0.001) and adherence to the protocol (p = 0.022) were the only independent variables with prognostic significance for perioperative blood glucose control. In 17 patients (15%) minor electrolyte disturbances occurred. No patient had frank ketosis. Duration of disease, presence of complications, type of anaesthesia and operation did not affect perioperative diabetes control.(ABSTRACT TRUNCATED AT 250 WORDS)
Jaspers
C A
CA
Department of Internal Medicine, Sint Franciscus Gasthuis, Rotterdam, Netherlands.
Elte
J W
JW
Olthof
G
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis; D003920:Diabetes Mellitus / Q000097:blood / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011300:Preoperative Care; D013514:Surgical Procedures, Operative
D001786:Blood Glucose