Diabetes Management During Surgery Evolves

Personalized Approaches Key to Improved Outcomes

Surgical procedures for individuals with diabetes demand careful, tailored approaches, particularly concerning insulin regimens. Recent findings underscore the importance of customized care, with pharmacy teams playing a crucial role in pre-operative assessments to mitigate medication errors and optimize patient safety.

Advancements in Insulin Therapies

Novel insulins and technology have significantly improved diabetes management during the perioperative period, according to research in the British Journal of Anaesthesia. “Although the prevalence of diabetes is ∼10% in the community, it is ∼25% in the inpatient and surgical patients,” the authors wrote, emphasizing the need for optimized glycemic control to prevent chronic complications.

Diabetes-Related Hospitalizations on the Rise

Hospitalizations related to diabetes saw an increase between 2010 and 2019, climbing from 3079 to 3280.8 per 100,000 patients, according to the Journal of Clinical Medicine. Researchers attribute this rise to the simultaneous increase in diabetes cases, with the CDC reporting that 38.4 million people in the U.S. have diabetes.

Pharmacological and Non-Pharmacological Options

Various therapeutic options are available to mitigate diabetes complications, broadly categorized as pharmacological and non-pharmacological. These include rapid-acting insulin analogues, regular soluble human insulin, intermediate-acting insulin, long-acting insulin analogues, and ultralong-acting insulin analogues.

Challenges in Perioperative Settings

Despite advancements in diabetes management, surgery on individuals with diabetes carries a mortality risk ranging from 3.7% to 13.2%. Current insulin methods being explored perioperatively include glucose–insulin–potassium regimen, variable rate intravenous insulin infusion (VRIII), basal-only insulin, and basal-bolus insulin.

The Role of Pharmacy Teams

According to the study authors, “The management of diabetes during the perioperative period should begin as soon as the decision to proceed with a surgical procedure is made.” Pharmacy teams play a vital role in ensuring safe medication administration during this period, particularly in pre-assessment clinics.

Personalized Approach is Essential

Prior to operations, pharmacists must understand the appropriate insulin regimens to best accommodate patients, since individuals with diabetes undergoing surgery require a highly personalized approach. The American Diabetes Association recommends regular monitoring and adjustments to treatment plans to manage blood sugar levels effectively, especially before, during, and after surgery (ADA, 2024).

Future Developments

“This review has discussed the current state of the safe use of insulin medicines during surgery and critical care admission; however, it is expected that further medications and drug delivery systems will be developed, and thus strategies will continue to evolve,” the authors concluded, noting the importance of maintaining safe glucose concentrations and preventing adverse drug events.