title: Use of a glucose management service improves glycemic control following vascular surgery: an interrupted time-series study.
abstract: BACKGROUND
  The optimal method for obtaining good blood glucose control in noncritically ill patients undergoing peripheral vascular surgery remains a topic of debate for surgeons, endocrinologists, and others involved in the care of patients with peripheral arterial disease and diabetes. A prospective trial was performed to evaluate the impact of routine use of a glucose management service (GMS) on glycemic control within 24 hours of lower-extremity revascularization (LER).
  
  
  METHODS
  In an interrupted time-series design (May 1, 2011-April 30, 2012), surgeon-directed diabetic care (Baseline phase) to routine GMS involvement (Intervention phase) was compared following LER. GMS assumed responsibility for glucose management through discharge. The main outcome measure was glycemic control, assessed by (1) mean hospitalization glucose and (2) the percentage of recorded glucose values within target range. Statistical process control charts were used to assess the impact of the intervention.
  
  
  RESULTS
  Clinically important differences in patient demographics were noted between groups; the 19 patients in the Intervention arm had worse peripheral vascular disease than the 19 patients in the Baseline arm (74% critical limb ischemia versus 58%; p = .63). Routine use of GMS significantly reduced mean hospitalization glucose (191 mg/dL Baseline versus 150 mg/dL Intervention, p < .001). Further, the proportion of glucose values in target range increased (48% Baseline versus 78% Intervention, p = .05). Following removal of GMS involvement, measures of glycemic control did not significantly decrease for the 19 postintervention patients.
  
  
  CONCLUSIONS
  Routine involvement of GMS improved glycemic control in patients undergoing LER. Future work is needed to examine the impact of improved glycemic control on clinical outcomes following LER.
authors.affiliation: Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.
authors.forename: Jessica B
authors.initials: JB
authors.lastname: Wallaert
authors.forename: Sushela S
authors.initials: SS
authors.lastname: Chaidarun
authors.forename: Danielle
authors.initials: D
authors.lastname: Basta
authors.forename: Kathryn
authors.initials: K
authors.lastname: King
authors.forename: Richard
authors.initials: R
authors.lastname: Comi
authors.forename: Greg
authors.initials: G
authors.lastname: Ogrinc
authors.forename: Brian W
authors.initials: BW
authors.lastname: Nolan
authors.forename: Philip P
authors.initials: PP
authors.lastname: Goodney
mesh_terms: D000368:Aged; D001786:Blood Glucose; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000188:drug therapy; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D065186:Interrupted Time Series Analysis; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration*; D016491:Peripheral Vascular Diseases / Q000209:etiology / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D011787:Quality of Health Care / Q000458:organization & administration*; D014656:Vascular Surgical Procedures
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents