Advertisement

Improved postoperative blood glucose control through implementation of clinical pharmacist driven glycemic management model after colorectal surgery

Published:December 26, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.12.018

      Highlights

      • Pharmacist driven glycemic management improves glycemic control after surgery.
      • Observed tighter glycemic control without increased rates of hypoglycemia.
      • Reducing workload for surgeons through expansion of the postoperative team.

      Abstract

      Background

      Poor postoperative glycemic control has been linked with higher mortality, cardiovascular complications, stroke, infection, impaired wound healing, and increased length of stay.

      Methods

      This multicenter, retrospective study of colorectal surgery patients with Type 2 Diabetes Mellitus evaluated the difference in mean blood glucose levels postoperatively in a pharmacist driven glycemic management model vs standard of care. Secondary objectives assessed hyperglycemic events, severe hyperglycemia, hypoglycemia, postoperative infection, and rates of endocrinology consults.

      Results

      186 patients were included, 120 in the pharmacist driven cohort and 66 in the standard of care. The pharmacist managed cohort demonstrated significantly lower mean blood glucose (133.9 vs 148.3 mg/dL, 95% CI [-17 to −11] p < 0.001), significantly fewer hyperglycemic events (9.6% vs 20.5%, p < 0.0001), and non-significant reduction of hypoglycemic events (0.7% vs 1.2%, p = 0.1443).

      Conclusions

      Expansion of the postoperative care team by utilizing pharmacists to manage postoperative blood glucose resulted in improved glycemic control.

      Graphical abstract

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Boyle J.P.
        • Thompson T.J.
        • Gregg E.W.
        • Barker L.E.
        • et al.
        Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence.
        Popul Health Metrics. 2010; 8: 29https://doi.org/10.1186/1478-7954-8-29
        • Drincic A.T.
        • Akkireddy P.
        • Knezevich J.T.
        Common models used for inpatient diabetes management.
        Curr Diabetes Rep. 2018; 18: 10https://doi.org/10.1007/s11892-018-0972-x
        • Vongsumran N.
        • Buranapin S.
        • Manosroi W.
        Standardized glycemic management versus conventional glycemic management and postoperative outcomes in type 2 diabetes patients undergoing elective surgery.
        Diabetes Metab Syndr Obes. 2020; 13 (10.2147%2FDMSO.S262444): 2593-2601
        • Kwon S.
        • Thompson R.
        • Dellinger P.
        • et al.
        Importance of perioperative glycemic control in general surgery: a report from the Surgical Care and Outcomes Assessment Program.
        Ann Surg. 2013; 257: 8-14https://doi.org/10.1097/sla.0b013e31827b6bbc
        • American Diabetes Association
        Economic costs of diabetes in the U.S. in 2012.
        Diabetes Care. 2013; 36 (10.2337%2Fdc12-2625): 1033-1046
        • Umpierrez G.E.
        • Isaacs S.D.
        • Bazargan N.
        • et al.
        Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes.
        J Clin Endocrinol Metab. 2002; 87: 978-982https://doi.org/10.1210/jcem.87.3.8341
        • Wang Y.Y.
        • Hu S.F.
        • Ying H.M.
        • et al.
        Postoperative tight glycemic control significantly reduces postoperative infection rates in patients undergoing surgery: a meta-analysis.
        BMC Endocr Disord. 2018; 18: 42https://doi.org/10.1186/s12902-018-0268-9
        • Tan D.J.H.
        • Yaow C.Y.L.
        • Mok H.T.
        • et al.
        The influence of diabetes on postoperative complications following colorectal surgery.
        Tech Coloproctol. 2021; 25 (10.1007%2Fs10151-020-02373-9): 267-278
        • Kalra S.
        • Bajwa S.J.
        • Baruah M.
        • et al.
        Hypoglycaemia in anesthesiology practice: diagnostic, preventive, and management strategies.
        Saudi J Anaesth. 2013; 7: 447-452https://doi.org/10.4103/1658-354x.121082
        • Hodges A.
        • Hall J.
        • Castellanos E.
        • et al.
        Implementing a pharmacist consultation model for multimodal insulin therapy.
        Am J Health Syst Pharm. 2017; 74: e224-e229https://doi.org/10.2146/ajhp150941
        • Mularski K.S.
        • Yeh C.P.
        • Bains J.K.
        • et al.
        Pharmacist glycemic control team improves quality of glycemic control in surgical patients with perioperative dysglycemia.
        Perm J. 2012; 16 (10.7812%2Ftpp%2F11-131): 28-33
        • Ata A.
        • Lee J.
        • Bestle S.L.
        • et al.
        Postoperative hyperglycemia and surgical site infection in general surgery patients.
        Arch Surg. 2010; 145: 858-864https://doi.org/10.1001/archsurg.2010.179
        • Warrington L.
        • Ayers P.
        • Baldwin A.M.
        • et al.
        Implementation of a pharmacist-led, multidisciplinary diabetes management team.
        Am J Health Syst Pharm. 2012; 69: 1240-1245https://doi.org/10.2146/ajhp110297
        • Long C.A.
        • Fang Z.B.
        • Hu F.Y.
        • et al.
        Poor glycemic control is a strong predictor of postoperative morbidity and mortality in patients undergoing vascular surgery.
        J Vasc Surg. 2019; 69: 1219-1226https://doi.org/10.1016/j.jvs.2018.06.212
        • Cook C.A.
        • Vakayil V.
        • Pribyl K.
        • et al.
        A pharmacist-driven glycemic control protocol to reduce the rate of severe hypoglycemia in high-risk patients.
        Hosp Pharm. 2020; https://doi.org/10.1177/0018578720973891
        Date accessed: February 4, 2022