PERIOPERATIVE GLYCEMIC MANAGEMENT OF DIABETIC PATIENTS

Uncontrolled perioperative glucose levels have been demonstrated to affect outcomes of Type 2 diabetics and non-diabetics undergoing surgical procedures to a lack of standardized protocols to manage hyperglycemic events, patients are at increased risk of infection, hospital lengths of stay, morbidity, and mortality (Cho et al., 2018; Duggan & Chen, 2019; Joslin Diabetes Center, 2019; Nair, Horibe, et al., 2016; Vogt & Bally, 2020). Appropriate perioperative blood glucose management is critical to enhancing health outcomes, shortening hospital length of stay, and reducing the need for hospital readmission (ADA, 2020). METHODS: Retrospective chart audits were conducted as part of a quality improvement project. Proper adherence to a glycemic management protocol was compared before and after education was provided to anesthesia providers. Data were obtained from the electronic health records of patients with type 2 diabetes mellitus who underwent general anesthesia at a regional medical center hospital in Southern California. A total of 100 preintervention and 100 postintervention charts were included in the data collection sample. INTERVENTION: Optimal control of perioperative blood glucose levels is facilitated by a detailed, evidence-based protocol that clinicians can efficiently comprehend and employ. The Emory University School of Medicine Perioperative Insulin Management Protocol was used to educate anesthesia providers at a Southern California medical center. Retrospective chart audits were done to assess provider patterns of diabetic care and patient glycemic outcomes before protocol education and post-education. The efficacy of educational outcomes can be evaluated by performing chart reviews and identifying deviations from recommended protocols and suboptimal glycemic outcomes.

RESULTS: Intraoperative blood glucose checks had a statistically significant gain from 14% to 39% (p = <0.001). Other process measures, such as frequency of insulin administration, and outcome measures, such as patient blood glucose control, were without significant change. These results indicated a continued deficiency in proper intraoperative glucose monitoring and insulin administration. CONCLUSION: Despite improved assessment of blood glucose, it is recommended that further inquiry to identify barriers that hinder compliance with the proposed protocol among anesthesia providers and initiation of targeted interventions to optimize perioperative glucose management in patients be initiated.