Relationship Between the Timing of Preoperative Medical Visits and Day-Of-Surgery Glucose in Poorly Controlled Diabetes

Abstract

Background: This study evaluated referral patterns for preoperative evaluations of patients with poorly controlled diabetes mellitus (DM) and determined whether intervals between evaluations and surgery day were associated with preoperative glucose levels. Results/methodology: In this retrospective analysis of DM patients with a hemoglobin A_1c level greater than 8.0%, of the 163 patients who underwent preoperative medical evaluation, only 45% were evaluated by endocrinology. Patients who had surgery earlier than 10 days after the preoperative medical evaluation had preoperative glucose levels 18% higher than those of patients who waited more than 10 days. Preoperative outpatient contact with endocrinology was not associated with preoperative glucose level (p = 0.90). Conclusion: For poorly controlled DM, more than 10 days are needed to achieve preoperative glycemic control.

Lay abstract: High blood sugar (hyperglycemia) can lead to surgical complications in patients with diabetes mellitus. It is best to identify patients in need of better glucose control before the day of surgery and allow enough time for them to treat their hyperglycemia. This study of patients with poorly controlled diabetes (with hemoglobin A_1c levels of more than 8.0%) found that more than 10 days is needed to improve blood sugar control if a high hemoglobin A_1c is detected. More effective ways of identifying these patients are needed to permit enough time to treat hyperglycemia before surgery.

Keywords::

• anesthesia
• diabetes mellitus
• hyperglycemia
• perioperative
• surgery

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved.

Author contributions

SI Patel: data extraction and manuscript preparation; BM Thompson: study oversight and manuscript preparation; RY McLemore: statistical analysis; M Temkit: statistical analysis; RT Schlinkert: manuscript review/preparation; HA Apsey: manuscript review/preparation; CB Cook: manuscript review/preparation.