Factors Associated with Increases in Glucose Levels in the Perioperative Period in Non-Diabetic Patients


Background: Blood glucose levels are elevated during the perioperative period as a result of the neuro-endocrine response to the stress of surgery. In nondiabetic patients, blood glucose levels are not a part of routine preoperative testing nor are they monitored during surgery or in the post anesthesia care unit (PACU). We measured blood glucose levels in nondiabetic patients during the perioperative period to identify how many patients had high glucose levels and what factors were associated with increases in blood glucose levels. Methods: This prospective observational study included two hundred and ninety five nondiabetic patients between the ages of 18 and 80 years, undergoing elective noncardiac surgery. Blood glucose levels were measured preoperatively and at frequent, predetermined intervals during surgery and in the PACU. Patient characteristics, surgical and anesthetic factors, and pain scores in the PACU were recorded, as were postoperative complications. Results: Forty nine percent (49%) of the patients had maximum intraoperative glucose levels of 126 mg/dl or higher and fifty three percent (53%) had maximum postoperative glucose levels of 126 mg/dl or higher. Preoperative glucose levels, family history of diabetes and amount of blood loss were statistically significantly associated with both max-intra-op and max-post-op glucose levels. Additionally, blood administration, surgery duration and race were significantly associated with max-intra-op glucose levels, while amount of intravenous fluids and sex were significantly associated with max-post-op glucose levels. Conclusion: A large number of nondiabetic patients in our study had maximum glucose levels >126 mg/dl in the perioperative period. Certain patient characteristics, as well as surgical/anesthetic factors, were associated with increases in the glucose levels. More studies are indicated to determine which patients may benefit from glucose monitoring in the perioperative period.

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V. Tilak, C. Schoenberg, A. Castro III and M. Sant, "Factors Associated with Increases in Glucose Levels in the Perioperative Period in Non-Diabetic Patients," Open Journal of Anesthesiology, Vol. 3 No. 3, 2013, pp. 176-185. doi: 10.4236/ojanes.2013.33042.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] H. L. Lazar, S. R. Chipkin, C. A. Fitzgerald, Y. Bao, H. Cabral and C. S. Apstein, “Tight Glycemic Control in Diabetic Coronary Artery Bypass Graft Patients Improves Perioperative Outcomes and Decreases Recurrent Ischemic Events,” Circulation, Vol. 109, No. 12, 2004, pp. 1497-1502. doi:10.1161/01.CIR.0000121747.71054.79
[2] A. Ouattara, P. Lecomte, M. Y. Le, M. Landi, S. Jacqueminet, I. Platonov, et al., “Poor Intraoperative Blood Glucose Control Is Associated with a Worsened Hospital Outcome after Cardiac Surgery in Diabetic Patients,” Anesthesiology, Vol. 103, No. 4, 2005, pp. 687-694. doi:10.1097/00000542-200510000-00006
[3] G. van den Berghe, P. Wouters, F. Weekers, C. Verwaest, F. Bruyninckx, M. Schetz, et al., “Intensive Insulin Therapy in Critically Ill Patients,” New England Journal of Medicine, Vol. 345, No. 19, 2001, pp. 1359-1367.
[4] J. S. Krinsley, “Effect of an Intensive Glucose Management Protocol on the Mortality of Critically Ill Adult Patients,” Mayo Clinic Proceedings, Vol. 79, No. 8, 2004, pp. 992-1000. doi:10.4065/79.8.992
[5] The Nice-Sugar Study Investigators. “Intensive versus Conventional Glucose Control in Critically Ill Patients,” New England Journal of Medicine, Vol. 360, No. 13, 2009, pp. 1283-1297. doi:10.1056/NEJMoa0810625
[6] A. Frisch, P. Chandra, D. Smiley, L. Peng, M. Rizzo, C. Gatcliffe, et al., “Prevalence and Clinical Outcome of Hyperglycemia in the Perioperative Period in Non Cardiac Surgery,” Diabetes Care, Vol. 33, No. 8, 2010, pp. 1783-1788. doi:10.2337/dc10-0304
[7] S. Kwon, R. Thompson, P. Dellinger, D. Yanez, E. Farrohki and D. Flum, “Importance of Perioperative Glycemic Control in General Surgery: A Report from the Surgical Care and Outcomes Assessment Program,” Annals of Surgery, Vol. 257, No. 1, 2013, pp. 8-14. doi:10.1097/SLA.0b013e31827b6bbc
[8] American Diabetes Association. “Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus,” Diabetes Care, Vol. 26, No. 1, 2003, pp. S5-S20.
[9] L. R. Pasternak, “Preanesthesia Evaluation of the Surgical Patient,” ASA Refresher Courses in Anesthesiology, Vol. 24, 1996, pp. 205-219. doi:10.1097/00126869-199624000-00016
[10] J. P. Desborough, “The Stress Response to Trauma and Surgery,” British Journal of Anesthesiology, Vol. 85, No. 1, 2000, pp. 109-117. doi:10.1093/bja/85.1.109
[11] S. Akhtar, P. G. Barash and S. E. Inzucchi, “Scientific Principles and Clinical Implications of Perioperative Glucose Regulation and Control,” Anesthesia & Analgesia, Vol. 110, No. 2, 2010, pp. 478-497. doi:10.1213/ANE.0b013e3181c6be63
[12] A. K. Lipshutz and M. A. Gropper, “Perioperative Glycemic Control,” Anesthesiology, Vol. 110, No. 2, 2009, pp. 408-421.
[13] D. E. Griesdale, R. J. de Souza, R. M. van Dam, D. K. Heyland, D. J. Cook, A. Malhotra, et al., “Intensive Insulin Therapy and Mortality among Critically Ill Patients: A Meta-Analysis including NICE-SUGAR Study Data,” Canadian Medical Association Journal, Vol. 180, No. 8, 2009, pp. 821-827. doi:10.1503/cmaj.090206
[14] M. J. McGirt, G. F. Woodworth, B. S. Brooke, A. L. Coon, S. Jain, D. Buck, et al., “Hyperglycemia Independently Increases the Risk of Perioperative Stroke, Myocardial Infarction, and Death after Carotid Endarterectomy,” Neurosurgery, Vol. 58, No. 14, 2006, pp. 1066-1073. doi:10.1227/01.NEU.0000215887.59922.36
[15] M. Y. Rady, D. J. Johnson, B. M. Patel, J. S. Larson and R. A. Helmers, “Influence of Individual Characteristics on Outcome of Glycemic Control in Intensive Care Unit Patients with or without Diabetes Mellitus,” Mayo Clinic Proceedings, Vol. 80, No. 12, 2005, pp. 1558-1567. doi:10.4065/80.12.1558
[16] ASA Committee, “Statement on Routine Preoperative Laboratory and Diagnostic Testing: Standards and Practice Parameters Amended on October 22,” 2008.
[17] R. Valdez, P. W. Yoon, T. Liu and M. J. Khoury, “Family History and Prevalence of Diabetes in the US Population,” Diabetes Care, Vol. 30, No. 30, 2007, pp. 2517-2522. doi:10.2337/dc07-0720
[18] A. Thorell, J. Nygren and O. Ljungqvist, “Insulin Resistance: A Marker of Surgical Stress,” Current Opinion in Clinical Nutrition and Metabolic Care, Vol. 2, No. 1, 1999, pp. 69-78. doi:10.1097/00075197-199901000-00012
[19] A. Thorell, S. Efendic, M. Gutniak, T. Haggmark and O. Ljungqvist, “Insulin Resistance after Abdominal Surgery,” British Journal of Surgery, Vol. 81, No. 1, 1994, pp. 59-63. doi:10.1002/bjs.1800810120
[20] T. Schricker, A. Berroth, U. Pfeiffer, M. Schreiber, E. Malik, M. Schmidt, et al., “Influence of Vaginal versus Abdominal Hysterectomy on Perioperative Glucose Metabolism,” Anesthesia & Analgesia, Vol. 83, No. 5, 1996, pp. 991-995. doi:10.1213/00000539-199611000-00016
[21] A. Thorell, J. Nygren, P. Essen, M. Gutniak, A. Loftenius, B. Andersson and O. Ljungqvist, “The Metabolic Response to Cholecystectomy: Insulin Resistance after Open Compared with Laparoscopic Operation,” European Journal of Surgery, Vol. 162, No. 3, 1996, pp. 187-191.
[22] K. W. Cheng, C. L. Chen, Y. F. Cheng, C. C. Tseng, C. H. Wang, Y. S. Chen, et al., “Dextrose in the Banked Blood Products Does Not Seem to Affect the Blood Glucose Levels in Patients Undergoing Liver Transplantation,” World Journal of Gastroenterology, Vol. 11, 2005, pp. 2789-2791.
[23] W. F. Bower, P. Y. Lee, A. P. Kong, J. Y. Jiang, M. J. Underwood, J. C. Chan, et al., “Peri-Operative Hyperglycemia: A Consideration for General Surgery?” American Journal of Surgery, Vol. 199, No. 2, 2010, pp. 240-248. doi:10.1016/j.amjsurg.2009.04.010
[24] C. J. Zuurbier, P. J. Keijzers, A. Koeman, H. B. Van Wezel and M. W. Hollmann, “Anesthesia’s Effects on Plasma Glucose and Insulin and Cardiac Hexokinase at Similar Hemodynamics and without Major Surgical Stress in Fed Rats,” Anesthesia & Analgesia, Vol. 106, No. 1, 2008, pp. 135-142. doi:10.1213/01.ane.0000297299.91527.74
[25] C. C. Cowie, K. F. Rust, E. S. Ford, M. S. Eberhardt, D. D. Byrd-Holt, C. Li, D. E. Williams, et al., “Full Accounting of Diabetes and Pre-Diabetes in the US Population in 1988-1994 and 2005-2006,” Diabetes Care, Vol. 32, No. 2, 2009, pp. 287-294. doi:10.2337/dc08-1296
[26] D. Jezová, E. Juránková, A. Mosnárová, M. Kriska and I. Skultétyová, “Neuroendorcine Response during Stress with Relation to Gender Differences,” Acta Neurobiologiae Experimentalis (Wars), Vol. 56, 1996, pp. 779-785.
[27] B. M. Kudielka, D. H. Hellhammer and S. Wüst, “Why Do We Respond So Differently? Reviewing Determinants of Human Salivary Cortisol Responses to Challenge,” Psychoneuroendocrinology, Vol. 34, No. 1, 2009, pp. 2-18. doi:10.1016/j.psyneuen.2008.10.004
[28] P. Hans, A. Vanthuyne, P. Y. Dewandre, J. F. Brichant and V. Bonhomme, “ Blood Glucose Concentration Profile after 10 mg Dexamethasone in Non-Diabetic and Type 2 Diabetic Patients Undergoing Abdominal Surgery,” British Journal of Anesthesiology, Vol. 97, No. 4, 2006, pp. 164-170. doi:10.1093/bja/ael111
[29] M. B. Lukins and P. H. Manninen, “Hyperglycemia in Patients Administered Dexamethasone for Craniotomy,” Anesthesia & Analgesia, Vol. 100, No. 4, 2005, pp. 1129-1133. doi:10.1213/01.ANE.0000146943.45445.55
[30] J. A. Martyn, M. Kaneki and S. Yasuhara, “Obesity-Induced Insulin Resistance and Hyperglycemia: Etiologic Factors and Molecular Mechanisms,” Anesthesiology, Vol. 109, No. 1, 2008, pp. 137-148. doi:10.1097/ALN.0b013e3181799d45
[31] B. B. Kahn and J. S. Flier, “Obesity and Insulin Resistance,” Journal of Clinical Investigation, Vol. 106, No. 4, 2000, pp. 473-481. doi:10.1172/JCI10842
[32] A. H. Mokdad, E. S. Ford, B. A. Bowman, W. H. Dietz, F. Vinicor, V. S. Bales, et al., “Prevalence of Obesity, Diabetes, and Obesity-Related Health Risk Factors 2001,” Journal of American Medical Association, Vol. 289, No. 1, 2003, pp. 76-79. doi:10.1001/jama.289.1.76
[33] B. S. Karon, G. Y. Gandhi, G. A. Nuttall, S. C. Bryant, H. V. Schaff, M. M. McMahon, et al., “Accuracy of Roche Accu-Chek Inform Whole Blood Capillary, Arterial, and Venous Glucose Values in Patients Receiving Intensive Intravenous Insulin Therapy after Cardiac Surgery,” American Journal of Clinical Pathology, Vol. 127, No. 6, 2007, pp. 919-926. doi:10.1309/6RFQCKAAJGKWB8M4
[34] M. J. Rice, A. D. Pitkin and D. B. Coursin, “Review Article: Glucose Measurement in the Operating Room: More Complicated than It Seems,” Anesthesia & Analgesia, Vol. 110, No. 4, 2010, pp. 1056-1065.

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