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Continuous perioperative insulin infusion therapy for patients with type 2 diabetes undergoing bariatric surgery

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Abstract

Background

Continuous insulin infusion (CII) is proven to decrease morbidity and mortality in surgical critical care patients. This study compared standard insulin therapy with CII in type 2 diabetes patients undergoing elective bariatric surgical procedures in a community hospital.

Methods

A retrospective review investigated 350 bariatric surgical patients with type 2 diabetes who underwent perioperative treatment of hyperglycemia using either standard insulin therapy or CII. The 182 patients in group 1 underwent glucose monitoring and subcutaneous insulin treatment every 6 h, whereas the 168 patients in group 2 had CII treatment beginning in the preoperative holding area and monitored hourly for the next 24 h. The two groups were similar in demographic characteristics.

Results

There were no significant hypoglycemic episodes with perioperative CII. The mean perioperative insulin required was 5.8 U/h. The patients receiving CII had fewer postprocedure cholecystectomies, but a higher number of port-site infections.

Conclusions

Perioperative CII can be administered safely to diabetic patients undergoing bariatric surgery. The insulin requirements in this population are higher than expected. Our study showed a decrease in the number of postoperative cholecystectomies in the CII group, but no effect on the stricture rate and an increase in the number of patients with postoperative port-site infections.

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Acknowledgments

I acknowledge the diabetic nursing education team led by Bobbi Presser and Jennifer Barth, who were tireless in their work to educate the team on the use of these protocols. The nursing team in the operating room was led by Rochelle Baker and Angelina Haynes. Joe Sandor, MD, was instrumental in changing the anesthesia culture surrounding insulin drip use in the operating and perioperative areas. Beryl Ann McGuire, Wanda Salter, and Kelly Polak insisted on the accurate implementation of the protocols in the bariatric unit. We appreciate the consultation and editing of J. N. Buchwald, MA from Medwrite Medical Communications.

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Authors and Affiliations

  1. Scottsdale Bariatric Center, 10200 N. 92nd Street, Suite 225, Scottsdale, AZ, 85258, USA

    R. Blackstone, J. Kieran, M. Davis & L. Rivera

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  1. R. Blackstone
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  2. J. Kieran
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  3. M. Davis
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  4. L. Rivera
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Corresponding author

Correspondence to R. Blackstone.

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Blackstone, R., Kieran, J., Davis, M. et al. Continuous perioperative insulin infusion therapy for patients with type 2 diabetes undergoing bariatric surgery. Surg Endosc 21, 1316–1322 (2007). https://doi.org/10.1007/s00464-006-9100-0

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  • DOI: https://doi.org/10.1007/s00464-006-9100-0

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