Advertisement

Perioperative Care of the Orthopedic Patient with Diabetes Mellitus

  • Naina Sinha GregoryEmail author
  • C. Ronald MacKenzie
Chapter
  • 22 Downloads

Abstract

The number of people with diabetes continues to rise. In 2015, it was estimated that 30.3 million or 9.4% of the US population had diabetes (Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States. This number is expected to rise with significant implications in both the inpatient and outpatient settings. Patients with diabetes have three times the risk of being hospitalized. Evidence from several trials links inpatient hyperglycemia with poor outcomes including an increased risk of infection and higher mortality. As the number of patients with diabetes increases, so does the number of patients with diabetes having surgical procedures. Infection and impaired healing are significant concerns. As such perioperative glucose management remains an important challenge. In this chapter the key considerations and current evidence guiding management of the patient with diabetes in the perioperative setting is presented.

Keywords

Inpatient hyperglycemia Hypoglycemia Diabetes Perioperative setting 

References

  1. 1.
    Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States. (2017). https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf.
  2. 2.
    Jiang HJ, Stryer D, Friedman B, Andrews R. Multiple hospitalizations for patients with diabetes. Diabetes Care. 2003;26(5):1421–6.CrossRefGoogle Scholar
  3. 3.
    Umpierrez GE, Isaacs SD, Bazargan N, You X, Thaler LM, Kitabchi AE. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab. 2002;87(3):978–82.CrossRefGoogle Scholar
  4. 4.
    Centers for Disease Control and Prevention. National vital statistics report. Deaths: Final data for 2014. https://www.cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_04.pdf. 2016.
  5. 5.
    Bolognesi MP, Marchant MH, Viens NA, Cook C, Pietrobon R, Vail TP. The impact of diabetes mellitus on perioperative patient outcomes after total hip and knee arthroplasty in the United States. J Arthroplast. 2008;23(6 Suppl 1):92–8.CrossRefGoogle Scholar
  6. 6.
    Golden SH, Peart-Vigilance C, Kao WH, Brancati FL. Perioperative glycemic control and the risk of infectious complications in a cohort of adults with diabetes. Diabetes Care. 1999;22(9):1408–14.CrossRefGoogle Scholar
  7. 7.
    Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Bookin S, Kanhere V, Starr A. Glucose control lowers the risk of wound infection in diabetics after open heart operation. Ann Thorac Surg. 1997;63(2):356–61.CrossRefGoogle Scholar
  8. 8.
    Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO, et al. Continuous insulin infusions reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2003;125(5):1007–21.CrossRefGoogle Scholar
  9. 9.
    den Berghe V, Wouters P, Weekes F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in the critically ill patients. NEJM. 2001;345(19):1359–67.CrossRefGoogle Scholar
  10. 10.
    Khan NA, Ghali W, Cagliero E. Perioperative management of diabetes mellitus. UpToDate. (2018). www.uptodate.com. Accessed 29 May 2018.
  11. 11.
    Brandt M, Kehlet H, Binder C, Hagen C, McNeilly AS. Effect of epidural analgesia on the glycoregulatory endocrine response to surgery. Clin Endocrinol. 1976;5:107.CrossRefGoogle Scholar
  12. 12.
    Umpierrez GE, Hellman R, Korytkowski MT, Kosiborod M, Maynard GA, Montori VM, et al. Management of hyperglycemia in hospitalized patients in non-critical care settings: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2012;97:16–38.CrossRefGoogle Scholar
  13. 13.
    Han HS, Kang SB. Relations between long-term glycemic control and post-operative wound and infectious complications after total knee arthroplasty in type 2 diabetics. Clin Orthop Surg. 2013;5:118–23.CrossRefGoogle Scholar
  14. 14.
    Godshaw BM, Ojard CA, Adams TM, Chimento GF, Mohammed A, Waddell BS. Preoperative glycemic control predicts perioperative serum glucose levels in patients undergoing total joint arthroplasty. J Arthroplasty. 2018;S0883-5403(18)30219-5.Google Scholar
  15. 15.
    Trick WE, Scheckler WE, Tokars JI, Jones KC, Reppen ML, Smith EM, et al. Modifiable risk factors associated with deep sternal site infection after coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2000;119:108.CrossRefGoogle Scholar
  16. 16.
    Dronge AS, Perkal S, Kancir S, Concato J, Aslan M, Rosenthal RA. Long-term glycemic control and postoperative infectious complications. Arch Surg. 2006;141:375.CrossRefGoogle Scholar
  17. 17.
    Noordzij PG, Ooersman E, Schreiner F, Kertai MD, Feringa HH, Dunkelgrun M, et al. Increased preoperative glucose levels are associated with perioperative mortality in patients undergoing noncardiac, nonvascular surgery. Eur J Endocrinol. 2007;156:137–42.CrossRefGoogle Scholar
  18. 18.
    Yendamuri S, Fulda GJ, Tinkoff GH. Admission hyperglycemia as a prognostic indicator in trauma. J Trauma. 2003;55:33–8.CrossRefGoogle Scholar
  19. 19.
    Olsen MA, Nepple JJ, Riew KD, Lenke LG, Bridwell KH, Mayfield J, et al. Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Joint Surg Am. 2008;90:62–9.CrossRefGoogle Scholar
  20. 20.
    Mesotten D, Van den Berghe G. Glycemic targets and approaches to management of patient with critical illness. Curr Diab Rep. 2012;12(1):101–7.CrossRefGoogle Scholar
  21. 21.
    Joshi GP, Chung F, Vann MA, Ahmad S, Gan TJ, Goulson DT, et al. Society for ambulatory anesthesia consensus statement on perioperative blood glucose management in diabetic patients undergoing ambulatory surgery. Anesth Analg. 2010;111(6):1378–87.CrossRefGoogle Scholar
  22. 22.
    Clement S, Braithwaite SS, Magee MF, Ahmann A, Smith EP, Schafer RG, et al. Management of diabetes and hyperglycemia in hospitals. Diabetes Care. 2004;27(2):533–91.CrossRefGoogle Scholar
  23. 23.
    Wesorick D, O’Malley C, Rushakoff R, Larsen K, Magee M. Management of diabetes and hyperglycemia in the hospital: a practical guide to subcutaneous insulin use in the non-critically ill adult patient. J Hosp Med. 2008;3(5 Suppl):S17–28.CrossRefGoogle Scholar
  24. 24.
    Buchleitner AM, Martínez-Alonso M, Hernández M, Solà I, Mauricio D. Perioperative glycaemic control for diabetic patients undergoing surgery. Cochrane Database Syst Rev. 2012;9:CD007315.Google Scholar
  25. 25.
    Smiley DD, Umpierrez GE. Perioperative glucose control in the diabetic or nondiabetic patient. South Med J. 2006;99:580–9.CrossRefGoogle Scholar
  26. 26.
    Umpierrez GE, Smiley D, Jacobs S, Peng L, Temponi A, Mulligan P, et al. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes undergoing general surgery (RABBIT 2 surgery). Diabetes Care. 2011;34:256–61.CrossRefGoogle Scholar
  27. 27.
    Umpierrez GE, Smiley D, Hermayer K, Khan A, Olson DE, Newton C, et al. Randomized study comparing a basal-bolus with a basal plus correction insulin regimen for the hospital management of medical and surgical patients with type 2 diabetes: basal plus trial. Diabetes Care. 2013;36:2169–74.CrossRefGoogle Scholar
  28. 28.
    Demma LJ, Carlson KT, Duggan EW, Morrow JG 3rd, Umpierrez G. Effect of basal insulin dosage on blood glucose concentration in ambulatory surgery patients with type 2 diabetes. J Clin Anesth. 2017;36:184–8.CrossRefGoogle Scholar
  29. 29.
    Salpeter SR, Greyber E, Pasternak GA, Salpeter Posthumous EE. Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus. Cochrane Database Syst Rev. 2009;1, CD002967.Google Scholar
  30. 30.
    U.S. Food and Drug Administration. SGLT-2 inhibitors: drug safety communication – labels to include warnings about too much acid in the blood and serious urinary tract infections. https://www.fda.gov/drugs/drugsafety/ucm475463.htm. 15 May 2015.
  31. 31.
    Akhtar S, Barsh PG, Inzucchi SE. Scientific principles and clinical implications of perioperative glucose regulation and control. Anesth Analg. 2010;110(2):478–97.CrossRefGoogle Scholar
  32. 32.
    Mangano DT, Layug EL, Wallace A, Tateo I. Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. Multicenter Study of Perioperative Ischemia Research Group. N Engl J Med. 1996;335:1713–20.CrossRefGoogle Scholar
  33. 33.
    Juul AB, Wetterslev J, Kofoed-Enevoldsen A. Long-term postoperative mortality in diabetic patients undergoing major non-cardiac surgery. Eur J Anaesthesiol. 2004;21:523–9.CrossRefGoogle Scholar
  34. 34.
    Pittas AG, Siegel RD, Lau J. Insulin therapy for critically ill hospitalized patients: a meta-analysis of randomized controlled trials. Arch Intern Med. 2004;164:2005–11.CrossRefGoogle Scholar
  35. 35.
    Gandhi GY, Murad MH, Flynn DN, Erwin PJ, Cavalcante AB, Bay Nielsen H, et al. Effect of perioperative insulin infusion on surgical morbidity and mortality: systemic review and meta-analysis of randomized trials. Mayo Clin Proc. 2008;83:418–30.CrossRefGoogle Scholar
  36. 36.
    Wiener RS, Wiener DC, Larson RJ. Benefits and risks of tight glucose control in critically ill adults: a meta-analysis. JAMA. 2008;300:933–44.CrossRefGoogle Scholar
  37. 37.
    Griesdale DR, de Souza RJ, van Dam RM, Heyland DK, Cook DJ, Malhotra A, et al. Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data. CMAJ. 2009;180:821–7.CrossRefGoogle Scholar
  38. 38.
    Watkinson P, Barber MS, Young JD. Strict glucose control in the critically ill. BMJ. 2006;322:865–6.CrossRefGoogle Scholar
  39. 39.
    Moghissi ES, Korykowsku MT, Dinardo M, Einhorn D, Hellman R, Hirsch IB, et al. American Association of Clinical Endocrinologists, American Diabetes Association consensus statement on inpatient glycemic control. Diabetes Care. 2009;32:1119–31.CrossRefGoogle Scholar
  40. 40.
    American Diabetes Association. Diabetes care in the hospital. Sec 13.Standards of medical care in diabetes. Diabetes Care. 2016;39(Supp 1):s99–104.Google Scholar
  41. 41.
    Queale WS, Seidler JA, Brancati FL. Glycemic control and sliding scale use in medical inpatients with diabetes mellitus. Arch Intern Med. 1997;157:545–52.CrossRefGoogle Scholar
  42. 42.
    Umpierrez GE, Andres P, Smiley D, Prieto LM, Palacio A, Ceron M, et al. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes (Rabbitt 2 trial). Diabetes Care. 2007;30:2181–6.CrossRefGoogle Scholar
  43. 43.
    Bailon RM, Partlow BJ, Miller-Cage V. Continuous subcutaneous insulin infusion (insulin pump) therapy can be safety used in the hospital in select patients. Endocr Pract. 2009;15(1):24–9.CrossRefGoogle Scholar
  44. 44.
    Inpatient Diabetes Certification. Joint Commission. https://www.jointcommission.org/certification/inpatient_diabetes.aspx. Accessed May 2018.
  45. 45.
    Duggan E, Carlson K, Umpierrez G. Perioperative Hyperglycemia Management. Anesthesiology. March 2017;126(3):547–60.CrossRefGoogle Scholar
  46. 46.
    Maynard G, Berg K, Kulasa K, et al. The Glycemic Control Implementaion Guide: Improving glycemic control, preventing hypoglycemia and optimizing care of the inpatient with hyperglycemia and diabetes. Society of Hospital Medicine. 2015;84:124–36.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.New York Presbyterian Hospital, Weill Cornell MedicineNew YorkUSA
  2. 2.Departments of Rheumatology and Medicine the Hospital for Special Surgery Weill Cornell MedicineNew YorkUSA

Personalised recommendations