Effect of basal insulin dosage on blood glucose concentration in ambulatory surgery patients with type 2 diabetes

• Published in: Journal of clinical anesthesia 2017-02, Vol.36, p.184-188
• Main Authors: Demma, Linda J., MD, PhD, Carlson, Karen T., MD, MBA, Duggan, Elizabeth W., MD, Morrow, John Gordon, MD, Umpierrez, Guillermo, MD
• Format: Article
• Language: English
• Subjects: Adult; Ambulatory care; Ambulatory Surgical Procedures; Anesthesia; Anesthesia & Perioperative Care; Blood glucose; Blood Glucose - drug effects; Body mass index; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - drug therapy; Drug Administration Schedule; Fasting; Female; Glargine insulin; Glucose; Glucose management; Humans; Hyperglycemia; Hyperglycemia - prevention & control; Hypoglycemia; Hypoglycemia - chemically induced; Hypoglycemia - prevention & control; Hypoglycemic Agents - administration & dosage; Hypoglycemic Agents - adverse effects; Hypoglycemic Agents - therapeutic use; Insulin Glargine - administration & dosage; Insulin Glargine - adverse effects; Insulin Glargine - therapeutic use; Insulin resistance; Male; Pain Medicine; Patients; Perioperative glycemic control; Perioperative insulin management; Postoperative Complications - prevention & control; Preoperative Care - methods; Surgeons; Surgery; Surgical outcomes
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2016.10.003

Abstract Study objective Among patients with type 2 diabetes treated with insulin, perioperative hyperglycemia and hypoglycemia may cause undesirable symptoms, surgery delay or cancellation, or unexpected hospitalization. Our objective was to compare preoperative glargine dosing regimens on perioperative glycemic control in patients undergoing ambulatory surgery. Design Observational study. Setting Pre- and postoperative holding areas. Patients One hundred fifty patients with type 2 diabetes using a once daily, evening insulin glargine regimen undergoing ambulatory surgery were included. Interventions None. Measurements To conduct the analysis, patients were divided into four groups based on the percentage of normal evening glargine dose taken. Group 1 took no glargine. Group 2 took 33%-57%. Group 3 took 60%-87% and Group 4 took 100% of their normal dose. The primary outcome was the proportion of patients in each group with blood glucose in the target range (100-180 mg/dL), and the incidence of hypoglycemia (defined as BG