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.

Researchers assessed which insulin regimens would be the most effective for patients with diabetes undergoing surgery. | image credit: miss irine / stock.adobe.com

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.

Diabetic Foot Ulcers: New Test Detects ‘Invisible’ Healing Issues

Breakthrough Measures Skin Barrier Function to Predict Re-Opening Risk

A novel approach to assessing diabetic foot ulcer (DFU) healing focuses not on how wounds *look*, but on what the skin subtly *reveals* – a measure of moisture loss that can predict whether an ulcer is truly closed or poised to re-open, potentially averting amputation.

Unveiling ‘Invisible Wounds’

Researchers led by Chandan K. Sen, PhD, MS, director of the McGowan Institute for Regenerative Medicine at the University of Pittsburgh, have developed a noninvasive tool to measure transepidermal water loss (TEWL). This assesses skin barrier function, identifying DFUs that appear healed but remain vulnerable beneath the surface.

The current US Food and Drug Administration definition of wound closure – intact skin with no drainage for two weeks – may be insufficient. Sen refers to these cases as “invisible wounds,” where impaired skin barrier function goes undetected. The new device quantifies water vapor escaping from the skin, providing an objective measure.

A Significant Problem

Approximately 31% of individuals with DFUs ultimately require amputation, and nearly half of those patients do not survive beyond five years. Ulcer recurrence is a major driver of this outcome, often occurring at the same site shortly after apparent closure.

According to the CDC, approximately 37.3 million Americans have diabetes, and 20% of those will develop a foot ulcer during their lifetime. CDC Data (2024)

“These findings echo previous calls in the literature to reframe wound healing as the beginning of remission rather than resolution.”

—Chandan K. Sen, PhD, MS

TEWL as a Predictor of Recurrence

In a study published in Diabetes Care, researchers used a handheld evaporimeter to measure water loss from DFUs that had achieved visual closure. Wounds with elevated TEWL values – indicating greater skin permeability – were significantly more likely to reopen compared to those with TEWL levels similar to healthy skin.

This physiologic marker offers a reproducible measure of skin barrier recovery, distinguishing between “cosmetically healed” wounds and those that are functionally sound. The TEWL approach emphasizes barrier restoration, not just epidermal reepithelialization.

Implications for Patient Care

The TEWL measurement could help clinicians determine which patients might benefit from continued offloading, advanced wound care dressings, or antimicrobial protection, even after a wound appears healed. This aligns with a growing trend toward long-term management and prevention in diabetic foot care.

Sen and his team suggest integrating TEWL as a complementary endpoint in both clinical care and regulatory definitions of healing. If validated in larger studies, TEWL could become a standard component of diabetic foot protocols, potentially reducing preventable amputations.

Ultimately, visual closure may be viewed as the start of a carefully monitored remission, guided by the subtle signal of water loss through the skin.

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