Diabetes, Hypoglycemia
Conditions
Keywords
perioperative hypoglycemia diabetes surgery, surgery
Brief summary
The purpose of the study is to review incidences of mild, moderate, and severe hypoglycemia in preoperative care units, operating rooms, and postanesthesia care units and analyze associated conditions and treatment.
Detailed description
With evidence linking surgical morbidity to hyperglycemia (high blood sugar), attention to glucose control is warranted during surgery as well as in the postoperative period. Consequently, measures to prevent and treat hyperglycemia - coupled with fasting status - places patients at considerable risk for perioperative hypoglycemia (low blood sugar). Outpatient patient studies support that profound hypoglycemia can be deleterious and even fatal to patients. This descriptive study will utilize retrospective chart review to examine factors associated with hypoglycemia. Charts from 700 subjects who experienced blood glucose values less than 70 mg/dl primarily in the preoperative and postanesthesia care units at William Beaumont Hospital-Royal Oak will be reviewed. Another 1600 charts will be screened for subsequent intraoperative hypoglycemia: 800 that had low normal preoperative glucose values and 800 that had high preoperative values (with likelihood of insulin therapy). Numerous factors believed to be associated with perioperative hypoglycemia will be analyzed including type and duration of diabetes, usual diabetes treatment regimen and alterations on day of surgery, self-reported usual fasting blood sugar range, duration of fasting, type of surgery and anesthesia, co-morbidities, and medications associated with hypoglycemia. Determining factors associated with perioperative hypoglycemia will improve prediction of which patients are at highest risk for hypoglycemia, enabling healthcare providers to institute more conservative insulin therapy when indicated, initiate early maintenance intravenous dextrose, and/ or perform more frequent glucose testing. Identifying associated factors will improve hypoglycemic predictions and interventions which should lead to safer, more effective care for patients with diabetes.
Interventions
None listed
Sponsors
Oakland University
Corewell Health East
Study design
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* Patients who underwent surgery at William Beaumont Hospital in Royal Oak, Michigan between January 1, 2003, and January 1, 2009. * Point of care testing identified a blood sugar value less than 69 mg/dl at any time in the perioperative area; or a value between 70-89 mg/dl in the preoperative area; or a glucose value greater than 250 mg/dl in the preoperative area.
Exclusion criteria
* Obstetric patients.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Hypoglycemia Incidence | perioperative period | Blood glucose values \<70 mg/dl |
Countries
United States
Participant flow
Recruitment details
Retrospective review of patients who underwent surgical procedures at our institution from 2003-2009
Pre-assignment details
Retrospective
Participants by arm
| Arm | Count |
|---|---|
| Low Normal Group Patients with diabetes who arrived in preoperative area with blood glucose values of 70-89 mg/dl | 308 |
| Hyperglycemia-treated Group Patients with diabetes who had preoperative blood glucose values \>249 mg/dl and were subsequently treated with insulin | 279 |
| Total | 587 |
Baseline characteristics
| Characteristic | Hyperglycemia-treated Group | Total | Low Normal Group |
|---|---|---|---|
| Age Continuous | 56.34 years STANDARD_DEVIATION 14.18 | 58.96 years STANDARD_DEVIATION 14.57 | 61.34 years STANDARD_DEVIATION 14.93 |
| Beta-blocker medication in regimen Documented Beta blocker use | 107 participants | 255 participants | 148 participants |
| Beta-blocker medication in regimen No documented beta blocker use | 172 participants | 332 participants | 160 participants |
| Diabetes type Type 1 diabetes | 47 participants | 84 participants | 37 participants |
| Diabetes type Type 2 diabetes | 175 participants | 392 participants | 217 participants |
| Diabetes type type not documented | 57 participants | 111 participants | 54 participants |
| Insulin regimen prior to preop arrival Insulin use | 240 participants | 506 participants | 266 participants |
| Insulin regimen prior to preop arrival No documented insulin use | 39 participants | 81 participants | 42 participants |
| Region of Enrollment United States | 279 participants | 587 participants | 308 participants |
| Renal disease Renal disease documented | 54 participants | 139 participants | 85 participants |
| Renal disease Renal disease not documented | 225 participants | 448 participants | 223 participants |
| Sex: Female, Male Female | 137 Participants | 279 Participants | 142 Participants |
| Sex: Female, Male Male | 142 Participants | 308 Participants | 166 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 |
Outcome results
Primary
Hypoglycemia Incidence
Blood glucose values \<70 mg/dl
Time frame: perioperative period
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Low Normal Group | Hypoglycemia Incidence | 53 participants |
| Hyperglycemia-treated Group | Hypoglycemia Incidence | 10 participants |
p-value: <0.00195% CI: [0.09, 0.18]Regression, Logistic