Comparison of perioperative glucose regulation in patients with type 1 vs type 2 diabetes mellitus: A retrospective cross‐sectional study
Background Most perioperative diabetes mellitus (DM) guidelines do not distinguish between patients with type 1 (DM1) and type 2 (DM2). We hypothesised that similar treatment of DM1 and DM2 patients leads to differences in their perioperative glucose control. Methods We performed a retrospective cro...
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| Veröffentlicht in: | Acta anaesthesiologica Scandinavica 2019-03, Vol.63 (3), p.314-321 |
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| container_title | Acta anaesthesiologica Scandinavica |
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| creator | Hulst, Abraham H. Polderman, Jorinde A. W. Kooij, Fabian O. Vittali, Dave Lirk, Philipp Hollmann, Markus W. DeVries, J. Hans Preckel, Benedikt Hermanides, Jeroen |
| description | Background
Most perioperative diabetes mellitus (DM) guidelines do not distinguish between patients with type 1 (DM1) and type 2 (DM2). We hypothesised that similar treatment of DM1 and DM2 patients leads to differences in their perioperative glucose control.
Methods
We performed a retrospective cross‐sectional study, of all DM patients undergoing surgery between May 2013 and November 2015 in a Dutch university hospital. We compared DM1 with DM2 patients, treated according to the same perioperative glucose protocol. Our primary outcome was the incidence of hyperglycaemia (glucose ≥10 mmol/L). Secondary outcomes were short‐term glycaemic control (glucose before surgery and peak glucose perioperatively), long‐term glycaemic control (HbA1c in 90 days before and after surgery) and the incidence of hypoglycaemia (glucose |
| doi_str_mv | 10.1111/aas.13274 |
| format | Article |
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Most perioperative diabetes mellitus (DM) guidelines do not distinguish between patients with type 1 (DM1) and type 2 (DM2). We hypothesised that similar treatment of DM1 and DM2 patients leads to differences in their perioperative glucose control.
Methods
We performed a retrospective cross‐sectional study, of all DM patients undergoing surgery between May 2013 and November 2015 in a Dutch university hospital. We compared DM1 with DM2 patients, treated according to the same perioperative glucose protocol. Our primary outcome was the incidence of hyperglycaemia (glucose ≥10 mmol/L). Secondary outcomes were short‐term glycaemic control (glucose before surgery and peak glucose perioperatively), long‐term glycaemic control (HbA1c in 90 days before and after surgery) and the incidence of hypoglycaemia (glucose <4 mmol/L).
Results
We included 2259 patients with DM, 216 (10%) of which had DM1. The calculated incidences in our population were 7 out of 1000 patients with DM1 and 69 out of 1000 patients with DM2. Compared to those with DM2, patients with DM1 were younger, had a lower BMI, a higher glucose concentration before surgery, and a higher perioperative peak glucose concentration (11.0 [8.2‐14.7] vs 9.4 [7.7‐11.7], P < 0.001). The incidence of the primary endpoint, perioperative hyperglycaemia, was significantly higher in DM1 compared to DM2 patients (63% vs 43%, P < 0.001). Hypoglycaemia occurred more often in the DM1 population (7.1% vs 1.3%, P < 0.001).
Conclusion
Providing similar perioperative treatment to patients with DM1 and DM2 is associated with poorer short‐term and long‐term glycaemic control in DM1 throughout the perioperative period as well as an increased risk of hypoglycaemia.</description><identifier>ISSN: 0001-5172</identifier><identifier>EISSN: 1399-6576</identifier><identifier>DOI: 10.1111/aas.13274</identifier><identifier>PMID: 30357807</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Adult ; Aged ; Blood Glucose - metabolism ; Body mass ; Control methods ; Cross-Sectional Studies ; Diabetes ; Diabetes mellitus ; Diabetes mellitus (insulin dependent) ; Diabetes mellitus (non-insulin dependent) ; Diabetes Mellitus, Type 1 - metabolism ; Diabetes Mellitus, Type 2 - metabolism ; Female ; Glucose ; Glucose - metabolism ; Glycated Hemoglobin A - analysis ; Humans ; Hyperglycemia ; Hyperglycemia - epidemiology ; Hypoglycemia ; Hypoglycemia - epidemiology ; Incidence ; Male ; Middle Aged ; Patients ; Perioperative Care ; Perioperative Period ; Postoperative Complications - epidemiology ; Retrospective Studies ; Surgery ; Treatment Outcome ; type 1 ; type 2</subject><ispartof>Acta anaesthesiologica Scandinavica, 2019-03, Vol.63 (3), p.314-321</ispartof><rights>2018 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd</rights><rights>2018 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.</rights><rights>Copyright © 2019 The Acta Anaesthesiologica Scandinavica Foundation</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3534-bfa0369e5ae162a7294bf9855cb17a59cbe79cd20b9170ab1b176402f74a29583</citedby><cites>FETCH-LOGICAL-c3534-bfa0369e5ae162a7294bf9855cb17a59cbe79cd20b9170ab1b176402f74a29583</cites><orcidid>0000-0001-8248-0244 ; 0000-0001-9101-7649 ; 0000-0003-2239-1260</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Faas.13274$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Faas.13274$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30357807$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hulst, Abraham H.</creatorcontrib><creatorcontrib>Polderman, Jorinde A. W.</creatorcontrib><creatorcontrib>Kooij, Fabian O.</creatorcontrib><creatorcontrib>Vittali, Dave</creatorcontrib><creatorcontrib>Lirk, Philipp</creatorcontrib><creatorcontrib>Hollmann, Markus W.</creatorcontrib><creatorcontrib>DeVries, J. Hans</creatorcontrib><creatorcontrib>Preckel, Benedikt</creatorcontrib><creatorcontrib>Hermanides, Jeroen</creatorcontrib><title>Comparison of perioperative glucose regulation in patients with type 1 vs type 2 diabetes mellitus: A retrospective cross‐sectional study</title><title>Acta anaesthesiologica Scandinavica</title><addtitle>Acta Anaesthesiol Scand</addtitle><description>Background
Most perioperative diabetes mellitus (DM) guidelines do not distinguish between patients with type 1 (DM1) and type 2 (DM2). We hypothesised that similar treatment of DM1 and DM2 patients leads to differences in their perioperative glucose control.
Methods
We performed a retrospective cross‐sectional study, of all DM patients undergoing surgery between May 2013 and November 2015 in a Dutch university hospital. We compared DM1 with DM2 patients, treated according to the same perioperative glucose protocol. Our primary outcome was the incidence of hyperglycaemia (glucose ≥10 mmol/L). Secondary outcomes were short‐term glycaemic control (glucose before surgery and peak glucose perioperatively), long‐term glycaemic control (HbA1c in 90 days before and after surgery) and the incidence of hypoglycaemia (glucose <4 mmol/L).
Results
We included 2259 patients with DM, 216 (10%) of which had DM1. The calculated incidences in our population were 7 out of 1000 patients with DM1 and 69 out of 1000 patients with DM2. Compared to those with DM2, patients with DM1 were younger, had a lower BMI, a higher glucose concentration before surgery, and a higher perioperative peak glucose concentration (11.0 [8.2‐14.7] vs 9.4 [7.7‐11.7], P < 0.001). The incidence of the primary endpoint, perioperative hyperglycaemia, was significantly higher in DM1 compared to DM2 patients (63% vs 43%, P < 0.001). Hypoglycaemia occurred more often in the DM1 population (7.1% vs 1.3%, P < 0.001).
Conclusion
Providing similar perioperative treatment to patients with DM1 and DM2 is associated with poorer short‐term and long‐term glycaemic control in DM1 throughout the perioperative period as well as an increased risk of hypoglycaemia.</description><subject>Adult</subject><subject>Aged</subject><subject>Blood Glucose - metabolism</subject><subject>Body mass</subject><subject>Control methods</subject><subject>Cross-Sectional Studies</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetes mellitus (insulin dependent)</subject><subject>Diabetes mellitus (non-insulin dependent)</subject><subject>Diabetes Mellitus, Type 1 - metabolism</subject><subject>Diabetes Mellitus, Type 2 - metabolism</subject><subject>Female</subject><subject>Glucose</subject><subject>Glucose - metabolism</subject><subject>Glycated Hemoglobin A - analysis</subject><subject>Humans</subject><subject>Hyperglycemia</subject><subject>Hyperglycemia - epidemiology</subject><subject>Hypoglycemia</subject><subject>Hypoglycemia - epidemiology</subject><subject>Incidence</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Patients</subject><subject>Perioperative Care</subject><subject>Perioperative Period</subject><subject>Postoperative Complications - epidemiology</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><subject>type 1</subject><subject>type 2</subject><issn>0001-5172</issn><issn>1399-6576</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kc9u1DAQxi0EokvhwAsgS1zaQ1r_ieM1t9WKAlIlDsA5crKT4iqJg8dptTfuXHhGnoTZTeGAhA_2N6OfPo_9MfZSigtJ69J7vJBa2fIRW0ntXFEZWz1mKyGELIy06oQ9Q7ylUpfOPWUnWmhj18Ku2I9tHCafAsaRx45PkEKkzedwB_ymn9uIwBPczD21iAkjn0jBmJHfh_yV5_0EXPI7XJTiu-AbyIB8gL4PecY3fEMOOUWcoD36tqTx1_efeKjj6HuOed7tn7Mnne8RXjycp-zL1dvP2_fF9cd3H7ab66LVRpdF03mhKwfGg6yUt8qVTefWxrSNtN64tgHr2p0SjZNW-EZSuyqF6mzplTNrfcrOFt8pxW8zYK6HgC1N60eIM9ZKKkNg6Qyhr_9Bb-OcaOIDRT-4lnQHUecLdXxYgq6eUhh82tdS1IeEakqoPiZE7KsHx7kZYPeX_BMJAZcLcB962P_fqd5sPi2WvwHlxpzs</recordid><startdate>201903</startdate><enddate>201903</enddate><creator>Hulst, Abraham H.</creator><creator>Polderman, Jorinde A. W.</creator><creator>Kooij, Fabian O.</creator><creator>Vittali, Dave</creator><creator>Lirk, Philipp</creator><creator>Hollmann, Markus W.</creator><creator>DeVries, J. Hans</creator><creator>Preckel, Benedikt</creator><creator>Hermanides, Jeroen</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-8248-0244</orcidid><orcidid>https://orcid.org/0000-0001-9101-7649</orcidid><orcidid>https://orcid.org/0000-0003-2239-1260</orcidid></search><sort><creationdate>201903</creationdate><title>Comparison of perioperative glucose regulation in patients with type 1 vs type 2 diabetes mellitus: A retrospective cross‐sectional study</title><author>Hulst, Abraham H. ; Polderman, Jorinde A. W. ; Kooij, Fabian O. ; Vittali, Dave ; Lirk, Philipp ; Hollmann, Markus W. ; DeVries, J. Hans ; Preckel, Benedikt ; Hermanides, Jeroen</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3534-bfa0369e5ae162a7294bf9855cb17a59cbe79cd20b9170ab1b176402f74a29583</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Blood Glucose - metabolism</topic><topic>Body mass</topic><topic>Control methods</topic><topic>Cross-Sectional Studies</topic><topic>Diabetes</topic><topic>Diabetes mellitus</topic><topic>Diabetes mellitus (insulin dependent)</topic><topic>Diabetes mellitus (non-insulin dependent)</topic><topic>Diabetes Mellitus, Type 1 - metabolism</topic><topic>Diabetes Mellitus, Type 2 - metabolism</topic><topic>Female</topic><topic>Glucose</topic><topic>Glucose - metabolism</topic><topic>Glycated Hemoglobin A - analysis</topic><topic>Humans</topic><topic>Hyperglycemia</topic><topic>Hyperglycemia - epidemiology</topic><topic>Hypoglycemia</topic><topic>Hypoglycemia - epidemiology</topic><topic>Incidence</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Patients</topic><topic>Perioperative Care</topic><topic>Perioperative Period</topic><topic>Postoperative Complications - epidemiology</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><topic>type 1</topic><topic>type 2</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hulst, Abraham H.</creatorcontrib><creatorcontrib>Polderman, Jorinde A. W.</creatorcontrib><creatorcontrib>Kooij, Fabian O.</creatorcontrib><creatorcontrib>Vittali, Dave</creatorcontrib><creatorcontrib>Lirk, Philipp</creatorcontrib><creatorcontrib>Hollmann, Markus W.</creatorcontrib><creatorcontrib>DeVries, J. Hans</creatorcontrib><creatorcontrib>Preckel, Benedikt</creatorcontrib><creatorcontrib>Hermanides, Jeroen</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Acta anaesthesiologica Scandinavica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hulst, Abraham H.</au><au>Polderman, Jorinde A. W.</au><au>Kooij, Fabian O.</au><au>Vittali, Dave</au><au>Lirk, Philipp</au><au>Hollmann, Markus W.</au><au>DeVries, J. Hans</au><au>Preckel, Benedikt</au><au>Hermanides, Jeroen</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of perioperative glucose regulation in patients with type 1 vs type 2 diabetes mellitus: A retrospective cross‐sectional study</atitle><jtitle>Acta anaesthesiologica Scandinavica</jtitle><addtitle>Acta Anaesthesiol Scand</addtitle><date>2019-03</date><risdate>2019</risdate><volume>63</volume><issue>3</issue><spage>314</spage><epage>321</epage><pages>314-321</pages><issn>0001-5172</issn><eissn>1399-6576</eissn><abstract>Background
Most perioperative diabetes mellitus (DM) guidelines do not distinguish between patients with type 1 (DM1) and type 2 (DM2). We hypothesised that similar treatment of DM1 and DM2 patients leads to differences in their perioperative glucose control.
Methods
We performed a retrospective cross‐sectional study, of all DM patients undergoing surgery between May 2013 and November 2015 in a Dutch university hospital. We compared DM1 with DM2 patients, treated according to the same perioperative glucose protocol. Our primary outcome was the incidence of hyperglycaemia (glucose ≥10 mmol/L). Secondary outcomes were short‐term glycaemic control (glucose before surgery and peak glucose perioperatively), long‐term glycaemic control (HbA1c in 90 days before and after surgery) and the incidence of hypoglycaemia (glucose <4 mmol/L).
Results
We included 2259 patients with DM, 216 (10%) of which had DM1. The calculated incidences in our population were 7 out of 1000 patients with DM1 and 69 out of 1000 patients with DM2. Compared to those with DM2, patients with DM1 were younger, had a lower BMI, a higher glucose concentration before surgery, and a higher perioperative peak glucose concentration (11.0 [8.2‐14.7] vs 9.4 [7.7‐11.7], P < 0.001). The incidence of the primary endpoint, perioperative hyperglycaemia, was significantly higher in DM1 compared to DM2 patients (63% vs 43%, P < 0.001). Hypoglycaemia occurred more often in the DM1 population (7.1% vs 1.3%, P < 0.001).
Conclusion
Providing similar perioperative treatment to patients with DM1 and DM2 is associated with poorer short‐term and long‐term glycaemic control in DM1 throughout the perioperative period as well as an increased risk of hypoglycaemia.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>30357807</pmid><doi>10.1111/aas.13274</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-8248-0244</orcidid><orcidid>https://orcid.org/0000-0001-9101-7649</orcidid><orcidid>https://orcid.org/0000-0003-2239-1260</orcidid></addata></record> |
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| subjects | Adult Aged Blood Glucose - metabolism Body mass Control methods Cross-Sectional Studies Diabetes Diabetes mellitus Diabetes mellitus (insulin dependent) Diabetes mellitus (non-insulin dependent) Diabetes Mellitus, Type 1 - metabolism Diabetes Mellitus, Type 2 - metabolism Female Glucose Glucose - metabolism Glycated Hemoglobin A - analysis Humans Hyperglycemia Hyperglycemia - epidemiology Hypoglycemia Hypoglycemia - epidemiology Incidence Male Middle Aged Patients Perioperative Care Perioperative Period Postoperative Complications - epidemiology Retrospective Studies Surgery Treatment Outcome type 1 type 2 |
| title | Comparison of perioperative glucose regulation in patients with type 1 vs type 2 diabetes mellitus: A retrospective cross‐sectional study |
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