Preoperative Glargine Dosing May Affect Perioperative Glycemic Control

Patients who received 100% of their normal insulin dose had the highest rate of hypoglycemia.
Patients who received 100% of their normal insulin dose had the highest rate of hypoglycemia.

In a cohort of patients with type 2 diabetes, the percentage of normal insulin dose given the evening before surgery directly affected perioperative glucose levels in ambulatory surgery, according to research published in the Journal of Clinical Anesthesia.

The observational study included 150 patients with type 2 diabetes who were on a once-daily, evening insulin glargine regimen and were undergoing ambulatory surgery. The researchers separated patients into 4 groups, depending on the rate of normal evening glargine dose taken: group 1, no glargine (n=5); group 2, 33% to 57% (n=23); group 3, 60% to 87% (n=49); and group 4, 100% (n=73).

The rate of patients in each group with blood glucose levels in the target range (100-180 mg/dL) served as the primary outcome measure. The safety end point was rate of hypoglycemia, which was defined as a blood glucose <70 mg/dL and/or symptomatic hyperglycemia requiring intervention during the perioperative course.

Data revealed that group 3 had the highest percentage of patients within the target range (78%; P <.001), whereas group 4 had the most patients with hypoglycemia (P =.01).

In addition, the likelihood of achieving target blood glucose was significantly greater for patients in group 3 than for either group 1 (P =.001) or group 4 (P =.002). There was no significant difference in attainment of target blood glucose between groups 2 and 3 (P =.56).

"[O]ur study shows that percent of normal evening insulin dose directly impacts perioperative glucose control in ambulatory surgery," the researchers concluded. "These results increase our understanding of perioperative blood glucose control in ambulatory surgical patients and have implications for prevention of hyper- and hypoglycemic events."

The researchers added that the optimal glargine dose in this setting, according to their findings, may be 75% of the normal dose.

Reference

Demma LJ, Carlson KT, Duggan EW, Morrow JG 3rd, Umpierrez G. Effect of basal insulin dosage on blood glucose concentration in ambulatory surgery patients with type 2 diabetes. J Clin Anesth. 2017;36;184-188. doi: 10.1016/j.jclinane.2016.10.003.

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