Glucose management team significantly improves glycaemic care and commitment to in-hospital guidelines within arthroplastic patients.
diabetes
diabetes education
glucose management
hyperglycaemia
implementation of guidelines
perioperative
Journal
Acta anaesthesiologica Scandinavica
ISSN: 1399-6576
Titre abrégé: Acta Anaesthesiol Scand
Pays: England
ID NLM: 0370270
Informations de publication
Date de publication:
Mar 2022
Mar 2022
Historique:
revised:
18
10
2021
received:
29
04
2021
accepted:
09
11
2021
pubmed:
7
12
2021
medline:
12
3
2022
entrez:
6
12
2021
Statut:
ppublish
Résumé
Perioperative dysglycaemias are a risk for harm but guidelines to improve glucose management are poorly adhered to. To determine whether a specialized team and diabetes education improves the implementation of guidelines and glucose values. We conducted a prospective study of 611 nonselected, consecutive patients attending for elective hip or knee arthroplasty. The first 209 patients received conventional care and the following 402 patients received intervention (Acute Glucose Service, AGS) in two chronological groups; either perioperatively (AGS1) or also preoperatively (AGS2). The AGS-team provided diabetes education, identified the patients with diabetes risk and adjusted the medication when needed. Capillary plasma glucose (CPG) was repeatedly measured and glycated haemoglobin (HbA1c) obtained before and after the surgery. The study objectives were to evaluate the staff actions when hyperglycaemia was severe (CPG >10 mmol/L), and to assess improvement of the glycaemic values and the complication rate within 3 months. None of the severely hyperglycaemic events in the reference group were treated according to guidelines. In the AGS 1 group, 50% and in the AGS2 group, 53% were appropriately managed (p < .001). The events of hyperglycaemia (CPG >7.8 mmol/L at least twice) and of severe hyperglycaemia (CPG >10 mmol/L) decreased in all patient groups. The medians of the highest, mean and variability of CPG values improved. The mean HbA1c improved significantly within AGS 2. There was no association between improved glycaemic care and early complications. AGS intervention significantly improves adherence to guidelines and glucose values.
Sections du résumé
BACKGROUND
BACKGROUND
Perioperative dysglycaemias are a risk for harm but guidelines to improve glucose management are poorly adhered to.
AIM
OBJECTIVE
To determine whether a specialized team and diabetes education improves the implementation of guidelines and glucose values.
METHODS
METHODS
We conducted a prospective study of 611 nonselected, consecutive patients attending for elective hip or knee arthroplasty. The first 209 patients received conventional care and the following 402 patients received intervention (Acute Glucose Service, AGS) in two chronological groups; either perioperatively (AGS1) or also preoperatively (AGS2). The AGS-team provided diabetes education, identified the patients with diabetes risk and adjusted the medication when needed. Capillary plasma glucose (CPG) was repeatedly measured and glycated haemoglobin (HbA1c) obtained before and after the surgery. The study objectives were to evaluate the staff actions when hyperglycaemia was severe (CPG >10 mmol/L), and to assess improvement of the glycaemic values and the complication rate within 3 months.
RESULTS
RESULTS
None of the severely hyperglycaemic events in the reference group were treated according to guidelines. In the AGS 1 group, 50% and in the AGS2 group, 53% were appropriately managed (p < .001). The events of hyperglycaemia (CPG >7.8 mmol/L at least twice) and of severe hyperglycaemia (CPG >10 mmol/L) decreased in all patient groups. The medians of the highest, mean and variability of CPG values improved. The mean HbA1c improved significantly within AGS 2. There was no association between improved glycaemic care and early complications.
CONCLUSIONS
CONCLUSIONS
AGS intervention significantly improves adherence to guidelines and glucose values.
Substances chimiques
Blood Glucose
0
Glycated Hemoglobin A
0
Hypoglycemic Agents
0
Glucose
IY9XDZ35W2
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
326-336Subventions
Organisme : the Olavi Lehtinen fund, Lahti
Organisme : the Päijät-Häme Cultural Foundation, Lahti
Organisme : the Finnish Diabetes Association
Organisme : Competetive Governmental Research Financing of the Expert Responsibility area of Helsinki University
ID : 2018 200230029
Organisme : Competetive Governmental Research Financing of the Expert Responsibility area of Helsinki University
ID : 2019 200230041
Organisme : the Tuovinen Foundation, Lahti, Finland.
Informations de copyright
© 2021 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
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