Management of diabetes during surgery. A retrospective study of 112 cases

In a retrospective study, glycaemic control on the day of surgery in 68 diabetic patients, managed by a diabetes team (group A), was compared with that in 44 managed by the surgeon and/or anaesthetist alone (group B). Group A insulin dependent patients and NIDDM undergoing major operations were treated by glucose-insulin-potassium infusion (16 units rapid-acting insulin + 10 mmol potassium chloride/500 ml 10% dextrose at 100 ml/h) modified according to blood glucose values (59 cases); well controlled NIDDM undergoing minor operations received no specific therapy (9 cases). Group B patients were treated by a wide variety of regimens. Blood glucose was measured on average 5 times on the operative day in team-managed patients and only twice in the other patients. One-third of the latter group had no glucose measurements at all. Blood glucose values were lower in team-managed patients. Adequate diabetic control, defined as mean blood glucose on the operation day below 216 mg/dl, without hypoglycaemia, was obtained in 82% of team patients but only in 58% of non-team patients. Control was particularly poor in NIDDM under-going major operations and not treated with GIK. Mortality and morbidity were similar in the two groups. We conclude that better glycaemic control was obtained in patients managed by a diabetic team using a glucose insulin potassium infusion. This approach is suitable for any general hospital which offers a diabetic service.