A retrospective sub‐study of perioperative glycaemia and insulin treatment for hospital inpatients at a quaternary centre from the specialist treatment of inpatients: Caring for diabetes in surgery trial ( STOIC ‐D Surgery)

AIMS: Surgical inpatients experience variable glycaemia, with hyper and hypoglycaemia, contributing towards increased morbidity and mortality. Understanding of mechanisms for glycaemic variability and clinician responses remains limited. We aimed to describe patterns of glycaemia in the immediate perioperative period and its drivers, including treatment with glucose-lowering agents. METHODS: This was a sub-analysis of participants in the STOIC-D Surgery trial, a randomised controlled trial of early specialist-led glycaemic management for inpatients with pre-admission diabetes or inpatient hyperglycaemia. Patients in this sub-study underwent at least one procedure during admission. Data from day prior to surgery, day of surgery and day after surgery were collected, including blood glucose levels and factors influencing glycaemia. RESULTS: 518 participants were included, with a mean HbA1c of 52 mmol/mol (6.9%). 295 (57%) patients received insulin during the three perioperative days; 130 (44%) of these insulin-receiving patients had a consistent increase in their total daily insulin dose across the 3 days. These patients had the highest perioperative glycaemia compared to patients with different insulin titration trends, particularly on the day of and day after surgery. Fasting duration was the only variable identified as being significantly associated with increased postoperative glycaemia. Hypoglycaemia was uncommon, occurring in 3% of all patients for each perioperative day. This was higher for patients receiving perioperatively insulin. CONCLUSIONS: This study characterised perioperative glycaemia trends and suggests that clinicians identify patients who require intensification of insulin treatment in the perioperative period, which needs to be counterbalanced with the risk of hypoglycaemia.