COMPLETE AUDIT CYCLE: PERI-OPERATIVE GLYCEMIC CONTROL IN CMH LAHORE

Authors

  • SZ BUTT Department of Surgery, CMH Lahore, Pakistan
  • T HAFEEZ Department of Surgery, CMH Lahore, Pakistan
  • MMA SIDDIQUI Department of Surgery, CMH Lahore, Pakistan
  • T FAYYAZ Department of Surgery, CMH Lahore, Pakistan
  • I AZIZ Department of Surgery, CMH Lahore, Pakistan
  • A IMRAN Department of Surgery, CMH Lahore, Pakistan
  • Y AHMED Department of Surgery, CMH Lahore, Pakistan
  • B ARIF Department of Surgery, CMH Lahore, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2023i1.256

Keywords:

Hyperglycemia, Diabetes, Stress-Induced Hyperglycemia, Post-Operative Complications, Glycemic Control, Insulin, NHS/ADA Guidelines, , Inpatient Diabetes, Wound Healing, Morbidity

Abstract

Hyperglycemia is associated with an increased risk of complications in patients undergoing surgery. Hyperglycemia from diabetes must be differentiated from stress-induced hyperglycemia, which typically presents post-operatively and resolves as the surgery-induced stress subsides. It is imperative to differentiate between the two due to the severe complications of diabetic hyperglycemia, which can often be confused with its stressed induced counterpart. Good glycemic control is the best strategy to avoid post-operative complications and morbidity. An assessment of peri-operative blood glucose levels of known diabetics admitted to CMH Lahore was done, and recommendations were introduced to achieve better glycemic control. Subsequently preventing post-surgical complications, improving wound healing and overall recovery, and ultimately decreasing morbidity. The aim of the audit was the assessment of peri-operative glycemic control in known diabetics admitted for surgery in CMH Lahore. Existing problems regarding poor glycemic control were identified, and recommendations were given to rectify said problems. We aimed to study the effectiveness of glucose control due to these planned interventions. Patients were included based on eligibility criteria, and a record of the patients was updated daily on the Excel sheet using the glucose control audit tool (attached below). The highest BSR reading per day was added. Good or poor glycemic control was determined by the highest BSR readings on post-op days 0, 1, and 2. If 2 or more readings met the criteria for good glycemic control, the patient was labeled to have good glycemic control. In Cycle 1, patients were managed peri-operatively with insulin as per the sliding scale. 13% of patients had good glycemic control on this regimen. Interventions were introduced for Cycle 2, with the recommendation of altering insulin/drug regimens as per NHS/ADA guidelines. 16.6% of patients were found to achieve good glycemic control; however, it was noted that these recommendations were not followed consistently. Based on the results, it can be concluded that the management of inpatient diabetes is a team effort, interventions recommended using established guidelines should be followed stringently, and existing protocols should be updated accordingly. Proper management of inpatient hyperglycemia starts with each team member performing their respective role to their best; this is vital in preventing post-operative complications associated with poor glycemic control.

Downloads

Download data is not yet available.

References

Aamir, A. H., Ul-Haq, Z., Mahar, S. A., Qureshi, F. M., Ahmad, I., Jawa, A., Sheikh, A., Raza, A., Fazid, S., and Jadoon, Z. (2019). Diabetes Prevalence Survey of Pakistan (DPS-PAK): prevalence of type 2 diabetes mellitus and prediabetes using HbA1c: a population-based survey from Pakistan. BMJ open 9, e025300.

Care, D. (2019). 15. Diabetes Care in the Hospital: Standards of Medical Care in. Diabetes Care 42, S173.

Dresner, A., Laurent, D., Marcucci, M., Griffin, M. E., Dufour, S., Cline, G. W., Slezak, L. A., Andersen, D. K., Hundal, R. S., and Rothman, D. L. (1999). Effects of free fatty acids on glucose transport and IRS-1–associated phosphatidylinositol 3-kinase activity. The Journal of clinical investigation 103, 253-259.

Duggan, E. W., Carlson, K., and Umpierrez, G. E. (2017). Perioperative hyperglycemia management: an update. Anesthesiology 126, 547-560.

Greci, L. S., Kailasam, M., Malkani, S., Katz, D. L., Hulinsky, I., Ahmadi, R., and Nawaz, H. (2003). Utility of HbA1c levels for diabetes case finding in hospitalized patients with hyperglycemia. Diabetes care 26, 1064-1068.

Inzucchi, S. E. FDA Drug Safety Communication: FDA Revises Warnings Regarding Use of the Diabetes Medicine Metformin in Certain Patients with Reduced Kidney Function.

Kotagal, M., Symons, R. G., Hirsch, I. B., Umpierrez, G. E., Dellinger, E. P., Farrokhi, E. T., and Flum, D. R. (2015). Perioperative hyperglycemia and risk of adverse events among patients with and without diabetes. Annals of surgery 261, 97.

Kwon, S., Thompson, R., Dellinger, P., Yanez, D., Farrohki, E., and Flum, D. (2013). Importance of perioperative glycemic control in general surgery: a report from the Surgical Care and Outcomes Assessment Program. Annals of surgery 257, 8.

Lee, Y.-Y., Lin, Y.-M., Leu, W.-J., Wu, M.-Y., Tseng, J.-H., Hsu, M.-T., Tsai, C.-S., Hsieh, A.-T., and Tam, K.-W. (2015). Sliding-scale insulin used for blood glucose control: a meta-analysis of randomized controlled trials. Metabolism 64, 1183-1192.

Moghissi, E. S., Korytkowski, M. T., DiNardo, M., Einhorn, D., Hellman, R., Hirsch, I. B., Inzucchi, S. E., Ismail-Beigi, F., Kirkman, M. S., and Umpierrez, G. E. (2009). American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Diabetes care 32, 1119-1131.

Santell, J. P., Hicks, R. W., McMeekin, J., and Cousins, D. D. (2003). Medication errors: experience of the United States Pharmacopeia (USP) MEDMARX reporting system. The Journal of Clinical Pharmacology 43, 760-767.

UK, N. G. C. (2020). Evidence review for blood glucose control management.

Umpierrez, G. E., Hellman, R., Korytkowski, M. T., Kosiborod, M., Maynard, G. A., Montori, V. M., Seley, J. J., and Van den Berghe, G. (2012). Management of hyperglycemia in hospitalized patients in non-critical care setting: an endocrine society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism 97, 16-38.

Wei, N. J., and Wexler, D. J. (2012). Perioperative Glucose Management. Hospital medicine clinics 1, e508.

Downloads

Published

2023-04-20

How to Cite

BUTT, S., HAFEEZ, T., SIDDIQUI, M., FAYYAZ, T., AZIZ, I., IMRAN, A., AHMED, Y., & ARIF, B. (2023). COMPLETE AUDIT CYCLE: PERI-OPERATIVE GLYCEMIC CONTROL IN CMH LAHORE. Biological and Clinical Sciences Research Journal, 2023(1), 256. https://doi.org/10.54112/bcsrj.v2023i1.256