Diabetes mellitus: standard perioperative care may be suboptimal in type 1 patients

Takeaway

• Patients with type 1 diabetes mellitus (DM) showed worse short-term and long-term glycaemic control during perioperative procedures and had greater risk for hypoglycaemia and hyperglycaemia.

Why this matters

• Similar clinical protocols for achieving glycaemic control during perioperative procedures do not differentiate between type 1 and type 2 DM.
• Study shows patients with type 1 DM receive suboptimal perioperative care.

Study design

• Study evaluated 2259 patients with DM undergoing elective procedures.
• Primary outcome: hyperglycaemia (glucose ≥10 mmol/L).
• Funding: Academic Medical Centre, Amsterdam, The Netherlands.

Key results

• 10% of patients had type 1 DM.
• Type 1 and 2 DM incidence rates per 1000 patients were 7 and 69, respectively.
• Mean age for patients with type 1 and 2 DM was 65 and 54 years, respectively.
• Compared with patients with type 2 DM, those with type 1 DM had significantly higher perioperative peak glucose concentration (11.0 vs 9.4; P<.001).
• Incidences of hyperglycaemia (63% vs 43%; P<.001) and hypoglycaemia (glucose <4 mmol/L; 7% vs 1%; P<.001) were significantly higher in patients with type 1 vs type 2 DM.
• Severe hypoglycaemia was more common in patients with type 1 DM (2% vs 0%; P<.001).

Limitations

• Retrospective cross‐sectional design.