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Surgical Endoscopy

Published in:

01-08-2007

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

Authors: R. Blackstone, J. Kieran, M. Davis, L. Rivera

Published in: Surgical Endoscopy | Issue 8/2007

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.

Hauner H (2004) Managing type 2 diabetes mellitus in patients with obesity (review). Treat Endocrinol 3: 223–232PubMedCrossRef

Dixon JB, Pories WJ, O’Brien PE, Schauer PR, Zimmet P (2005) Surgery as an effective early intervention for diabesity: why the reluctance? (review). Diabetes Care 28: 472–474PubMedCrossRef

MacDonald KG Jr, Long SD, Swanson MS, Brown BM, Morris P, Dohm GL, Pories WJ (1997) The gastric bypass operation reduces the progression and mortality of non–insulin-dependent diabetes mellitus. J Gastrointest Surg 1: 213–220PubMedCrossRef

Jacobs ML, Elte JW, van Ouwerkerk BM, Janssens EN, Schop C, Knoop JA, Hoogma RP, Groenendijk R, Weber RF (1997) Effect of BMI, insulin dose, and number of injections on glycaemic control in insulin-using diabetic patients. Studygroup Diabetes Rijnmond (SDR). Neth J Med 50: 153–159PubMedCrossRef

Ballantyne GH, Gumbs A, Modlin IM (2005) Changes in insulin resistance following bariatric surgery and the adipoinsular axis: role of the adipocytokines, leptin, adiponectin, and resistin (review). Obes Surg 15: 692–699PubMedCrossRef

Mannan MA, Rahman MS, Siddiqui NI (2004) Obesity management in patients with type 2 diabetes mellitus (review). Mymensingh Med J 13: 95–99PubMed

Wainstein J, Metzger M, Boaz M, Minuchin O, Cohen Y, Yaffe A, Yerushalmy Y, Raz I, Harman-Boehm I (2005) Insulin pump therapy vs multiple daily injections in obese type 2 diabetic patients. Diabet Med 22: 1037–1046PubMedCrossRef

Bin-Abbas BS, Sakati NA, Raef H, Al-Ashwal AA (2005) Continuous subcutaneous insulin infusion in type 1 diabetic Saudi children: a comparison with conventional insulin therapy. Saudi Med J 26: 918–922PubMed

Retnakaran R, DeVries JH, Hanaire-Broutin H, Heine RJ, Melki V, Zinman B (2005) Continuous subcutaneous insulin infusion versus multiple daily injections: modeling predicted benefits in relationship to baseline A1c. Diabetes Care 28: 1835–1836PubMedCrossRef

10.

Diniz Mde F, Diniz MT, Sanches SR, de Almeida Salgado PP, Valadao MM, Freitas CP, Vieira DJ (2004) Glycemic control in diabetic patients after bariatric surgery. Obes Surg 14: 1051–1055PubMedCrossRef

11.

Dixon JB, Dixon AF, O’Brien PE (2003) Improvements in insulin sensitivity and beta-cell function (HOMA) with weight loss in the severely obese. Diabet Med 20: 127–134PubMedCrossRef

12.

Zarich SW (2005) The role of intensive glycemic control in the management of patients who have acute myocardial infarction (review). Cardiol Clin 23: 109–117PubMedCrossRef

13.

Talbot TR (2005) Diabetes mellitus and cardiothoracic surgical-site infections. Am J Infect Control 33: 353–359PubMedCrossRef

14.

Furnary AP, Gao G, Grunkemeier GL, et al. (2003) Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg 125: 1007–1021PubMedCrossRef

15.

Krinsley J, Grissler B (2005) Intensive glycemic management in critically ill patients. Jt Comm J Qual Patient Saf 31: 308–312PubMed

16.

Furnary AP, Zerr KJ, Grunkemeier GL, Starr A (1999) Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. Ann Thorac Surg 67: 352–360, discussion 360–362PubMedCrossRef

17.

Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Kanhere V, Starr A (1997) Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg 63: 356–361PubMedCrossRef

18.

Van den Berghe G, Wouters P, Weekers F, et al. (2001) Intensive insulin therapy in the critically ill patients. N Engl J Med 345: 1359–1367PubMedCrossRef

19.

Furnary AP, Wu Y, Bookin SO (2004) Effect of hyperglycemia and continuous intravenous insulin infusions on outcomes of cardiac surgical procedures: the Portland Diabetic Project. Endocr Pract 10(Suppl 2): 2133

20.

Hansen TK, Thiel S, Wouters PJ, Christiansen JS, Van den Berghe G (2003) Intensive insulin therapy exerts antiinflammatory effects in critically ill patients and counteracts the adverse effect of low mannose-binding lectin levels. J Clin Endocrinol Metab 88:1082–1088PubMedCrossRef

21.

Mesotten D, Swinnen JV, Vanderhoydonc F, Wouters PJ, Van den Berghe G (2004) Contribution of circulating lipids to the improved outcome of critical illness by glycemic control with intensive insulin therapy. J Clin Endocrinol Metab 89: 219–226 PubMedCrossRef

22.

Vanhorebeek I, De Vos R, Mesotten D, Wouters PJ, De Wolf Peeters C, Van den Berghe G (2005) Protection of hepatocyte mitochondrial ultrastructure and function by strict blood glucose control with insulin in critically ill patients. Lancet 365: 53–59PubMedCrossRef

23.

Valensi P, Moura I, Le Magoarou M, Paries J, Perret G, Attali JR (1997) Short-term effects of continuous subcutaneous insulin infusion treatment on insulin secretion in non–insulin-dependent overweight patients with poor glycaemic control despite maximal oral antidiabetic treatment. Diabetes Metab 23: 51–57PubMed

24.

Wittgrove AC, Clark GW, Tremblay LJ (1994) Laparoscopic gastric bypass, Roux-en-Y. preliminary report of five cases. Obes Surg 4: 353–357PubMedCrossRef

25.

Pories WJ, Swanson MS, MacDonald KG, et al. (1995) Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg 222: 339–352PubMedCrossRef

26.

Buchwald H, Avidor Y, Braunwald E, Jensen M, Pories W, Fahrbach K, Schoelles K (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292: 1724–1737PubMedCrossRef

27.

Persson GE, Thulin AJ (1991) Prevalence of gallstone disease in patients with diabetes mellitus: a case-control study. Eur J Surg 157: 579–582PubMed

28.

Miller K, Hell E, Lang B, Lengauer E (2003) Gallstone formation prophylaxis after gastric restrictive procedures for weight loss. Ann Surg 238: 697–702PubMedCrossRef

Title: Continuous perioperative insulin infusion therapy for patients with type 2 diabetes undergoing bariatric surgery
Authors: R. Blackstone
J. Kieran
M. Davis
L. Rivera
Publication date: 01-08-2007
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 8/2007
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-006-9100-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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