Effect of a program to control perioperative blood glucose on the incidence of nosocomial infections in patients with diabetes: A pilot study


Aim: To evaluate the safety and effectiveness of a pilot program to control perioperative blood glucose in patients with diabetes. Methods: A pre-post intervention study was conducted in a 280-bed hospital in Spain. In the year 2008 we implemented perioperative insulin protocols aimed at blood glucose values from 80 to 180 mg/dL. Surgical patients with diabetes admitted on year 2009 (intervention group) were compared with a control group of patients with diabetes admitted for surgery on year 2007, matched 1:1 by traditional wound class. Results: We analyzed 96 patients. Implemented protocols were followed in 48% of patients intra-operatively and 75% of patients postoperatively. Patients in the intervention group had reductions in blood glucose at surgery 150 +/- 61 mg/dL vs. 172 +/- 53 mg/dL; p = 0.05), greater proportion of target glucose values throughout hospitalization (67% vs. 55%; p = 0.07), and reductions in the incidence of nosocomial infections after controlling for confounders (Odds Ratio: 0.20; 95% Confidence intervals: 0.06 - 0.72; p = 0.014) when they were compared with the control group: The incidence of hypoglycemia was similar between two groups (0.12% vs. 0.10%, p = 0.867), respectively. Conclusion: Although our protocol needs improvements to increase implementation it was useful to control blood glucose safely and for reducing nosocomial infections.

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Ena, J. , Casañ, R. , José Carratalá, M. and Leutscher, E. (2012) Effect of a program to control perioperative blood glucose on the incidence of nosocomial infections in patients with diabetes: A pilot study. Journal of Diabetes Mellitus, 2, 238-244. doi: 10.4236/jdm.2012.22038.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Estrada, C.A., Young, J.A., Nifong, L.W. and Chitwood, W.R. Jr. (2003) Outcomes and preoperative hyperglycemia in patients with or without diabetes mellitus undergoing coronary artery bypass grafting. The Annals of Thoracic Surgery, 75, 1392-1399. doi:10.1016/S0003-4975(02)04997-4
[2] Pomposelli, J.J., Baxter, J.K. 3rd., Babineau, T.J., Pomfret, E.A., Driscoll, D.F., Forse, R.A. and Bistrian, B.R. (1998) Early postoperative glucose control predicts nosocomial infection rate in diabetic patients. Journal of Parentereral and Enteral Nutrition, 22, 77-81. doi:10.1177/014860719802200277
[3] Trick, W.E., Scheckler, W.E., Tokars, J.I., Jones, K.C., Reppen, M.L., Smith, E.M. and Jarvis, W.R. (2000) Modifiable risk factors associated with deep sternal site infection after coronary artery bypass grafting. Journal of Thoracic and Cardiovascular Surgery, 119, 108-114. doi:10.1016/S0022-5223(00)70224-8
[4] Delamaire, M., Maugendre, D., Moreno, M., Le Goff, M.C., Allannic, H. and Genetet, B. (1997) Impaired leucocyte functions in diabetic patients. Diabetic Medicine, 14, 29-34. doi:10.1002/(SICI)1096-9136(199701)14:1<29::AID-DIA300>3.0.CO;2-V
[5] Furnary, A.P., Wu, Y. and Bookin, S.O. (2004) Effect of hyperglycemia and continuous intravenous insulin infusions on outcomes of cardiac surgical procedures: The Portland Diabetic Project. Endocrine Practice, 10, 21-33.
[6] Van den Berghe, G., Wouters, P., Weekers, F., Verwaest, C., Bruyninckx, F., Schetz, M., Vlasselaers, D., Ferdinande, P., Lauwers, P. and Bouillon, R. (2001) Intensive insulin therapy in the critically ill patients. New England Journal of Medicine, 345, 1359-1367. doi:10.1056/NEJMoa011300
[7] Mangram, A.J., Horan, T.C., Pearson, M.L., Silver, L.C. and Jarvis, W.R. (1999) Guideline for prevention of surgical site infection, 1999. Hospital infection control practices advisory committee. Infection Control and Hospital Epidemiology, 20, 250-278. doi:10.1086/501620
[8] Moghissi, E.S., Korytkowski, M.T., DiNardo, M., Einhorn, D., Hellman, R., Hirsch, I.B., Inzucchi, S.E., Ismail-Beigi, F., Kirkman, M.S. and Umpierrez, G.E. (2009) American Association of Clinical Endocrinologists and American Diabetes Association Consensus Statement on inpatient glycemic control. Diabetes Care, 32, 1119-1131. doi:10.2337/dc09-9029
[9] Ena, J., Casan, R., Lozano, T., Leach, A., Algado, J.T. and Navarro-Diaz, F.J. (2009) Long-term improvements in insulin prescribing habits and glycemic control in medical inpatients associated with the introduction of a standardized educational approach. Diabetes Research and Clinical Practice, 85, 159-165. doi:10.1016/j.diabres.2009.05.011
[10] D’Hoore, W., Sicotte, C. and Tilquin, C. (1993) Risk adjustment in outcome assessment: The Charlson comorbidity index. Methods of Information in Medicine, 32, 382-387.
[11] Knaus, W.A., Draper, E.A., Wagner, D.P. and Zimmerman, J.E. (1985) APACHE II: A severity of disease classification system. Critical Care Medicine, 13, 818-829. doi:10.1097/00003246-198510000-00009
[12] Owens, W.D., Felts, J.A. and Spitznagel, E.L. Jr. (1978) ASA physical status classifications: A study of consistency of ratings. Anesthesiology, 49, 239-243. doi:10.1097/00000542-197810000-00003
[13] Haley, R.W., Culver, D.H., Morgan, W.M., White, J.W., Emori, T.G. and Hooton, T.M. (1985) Identifying patients at high risk of surgical wound infection. A simple multivariate index of patient susceptibility and wound contamination. American Journal of Epidemiology, 121, 206-215.
[14] Emori, T.G., Culver, D.H., Horan, T.C., Jarvis, W.R., White, J.W., Olson, D.R., Banerjee, S., Edwards, J.R., Martone, W.J., Gaynes, R.P., et al. (1991) National nosocomial infections surveillance system (NNIS): Description of surveillance methods. American Journal of Infection Control, 19, 19-35. doi:10.1016/0196-6553(91)90157-8
[15] Horan, T.C., Gaynes, R.P., Martone, W.J., Jarvis, W.R. and Emori, T.G. (1992) CDC definitions of nosocomial surgical site infections, 1992: A modification of CDC definitions of surgical wound infections. Infection Control and Hospital Epidemiology, 13, 606-608. doi:10.1086/646436
[16] McKibben, L., Horan, T., Tokars, J.I., Fowler, G., Cardo, D.M., Pearson, M.L., Brennan, P.J. (2005) Guidance on public reporting of healthcare-associated infections: Recommendations of the healthcare infection control practices advisory committee. American Journal of Infection Control, 33, 217-226. doi:10.1016/j.ajic.2005.04.001
[17] Latham, R., Lancaster, A.D., Covington, J.F., Pirolo, J.S. and Thomas, C.S. (2001) The association of diabetes and glucose control with surgical-site infections among cardiothoracic surgery patients. Infection Control and Hospital Epidemiology, 22, 607-612. doi:10.1086/501830
[18] Furnary, A.P., Zerr, K.J., Grunkemeier, G.L. and Starr, A. (1999) Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. Annals of Thoracic Surgery, 67, 352-360. doi:10.1016/S0003-4975(99)00014-4
[19] Lazar, H.L., Chipkin, S.R., Fitzgerald, C.A., Bao, Y., Cabral, H. and Apstein, C.S. (2004) Tight glycemic control in diabetic coronary artery by pass graft patients improves preoperative outcomes and decreases recurrent ischemic events. Circulation, 109, 1497-1502. doi:10.1161/01.CIR.0000121747.71054.79
[20] Barcellos, C.S., Wender, O.C.B. and Azambuja, P.C. (2007) Clinical and haemodynamic outcome following coronary artery by pass surgery in diabetic patients using glucose-insulin-potassium (GIK) solution: A randomized clinical trial. Revista Brasileira de Cirurgia Cardiovascular, 22, 275-284. doi:10.1590/S0102-76382007000300002
[21] Vinik, R., Jones, R.E., Pendleton, R.C. and Ku, S.Y. (2009) Safety and efficacy of an infusion protocol designed for the non-intensive care setting. Endocrine Practice, 15, 682-688. doi:10.4158/EP09055.ORR
[22] NICE-SUGAR Study Investigators: Finfer, S., Chittock, D.R., Su, S.Y., Blair, D., Foster, D., Dhingra, V., Bellomo, R., Cook, D., Dodek, P., Henderson, W.R., Hébert, P.C., Heritier, S., Heyland, D.K., McArthur, C., McDonald, E., Mitchell, I., Myburgh, J.A., Norton, R., Potter, J., Robinson, B.G. and Ronco, J.J. (2009) Intensive versus conventional glucose control in critically ill patients. New England Journal of Medicine, 360, 1283-1297. doi:10.1056/NEJMoa0810625
[23] Nakamura, T., Onozato, W., Mitomi, H., Sato, T., Hatate, K., Naioto, M., Ihara, A. and Watanabe, M. (2009) Analysis of the risk factors for wound infection after surgical treatment of colorectal cancer: A matched case control study. Hepatogastroenterology, 56, 1316-1320.
[24] Romy, S., Eisenring, M.C., Bettschart, V., Petignat, C., Francioli, P. and Troillet, N. (2008) Laparoscope use and surgical site infections in digestive surgery. Annals of Surgery, 247, 627-632. doi:10.1097/SLA.0b013e3181638609
[25] Biscione, F.M., Couto, R.C., Pedrosa, T.M. and Neto, M.C. (2007) Comparison of the risk of surgical site infection after laparoscopic cholecystectomy and open cholecystectomy. Infection Control and Hospital Epidemiology, 28, 1103-1106. doi:10.1086/519931

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