Perioperative hyperglycemia is very common among critically ill patients with or without diabetes mellitus (DM). Perioperative elevated levels of blood glucose (BG) have been linked with increases in morbidity, infections, anastomotic failure, autoimmune dysfunction, and raised mortality and prolongation of hospitalization. A variety of different approaches have been taken for the control of BG in the perioperative period, and different methods of measurement have been proposed, among which, point of care (POC) meters, arterial blood gas analysis and venous plasma analysis prevail. The aim of this literature review was to provide evidence-based answers as to how BG levels should be monitored. We conclude that more conservative glycemic control is preferable to “tight glycemic control” (TGC), in order to avoid complications associated with episodes of hypoglycemia.
Glycemic control surgical patients perioperative hyperglycemia
This is a preview of subscription content, log in to check access.
Moghissi ES, Korytkowski MT, DiNardo M, et al. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Diabetes Care 2009; 32:1119–31.CrossRefPubMedPubMedCentralGoogle Scholar
Umpierrez GE, Hellman R, Korytkowski MT, et al.; Endocrine Society. Management of hyperglycemia in hospitalized patients in non-critical care setting: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2012;97: 16–38.CrossRefPubMedGoogle Scholar
Sathya B, Davis R, Taveira T, et al. Intensity of peri-operative glycemic control and postoperative outcomes in patients with diabetes: A meta-analysis. Diabetes Res Clin Pract 2013;102:8–15.CrossRefPubMedGoogle Scholar
Umpierrez G, Cardona S, Pasquel F, et al. Randomized controlled trial of intensive versus conservative glucose control in patients undergoing coronary artery bypass graft surgery: GLUCOCABG trial. Diabetes Care 2015; 38:1665–72.CrossRefPubMedPubMedCentralGoogle Scholar
Maynard G, Wesorick DH, O’Malley C, et al. Society of Hospital Medicine Glycemic Control Task Force. Subcutaneous insulin order sets and protocols: Effective design and implementation strategies. J Hosp Med 2008; 3(Suppl.):29–41.PubMedGoogle Scholar
Umpierrez GE, Reyes D, Smiley D, et al. Hospital discharge algorithm based on admission HbA1c for the management of patients with type 2 diabetes. Diabetes Care 2014; 37:2934–9.CrossRefPubMedPubMedCentralGoogle Scholar