Status and analysis of the patients in perioperative with insulin pump blood glycemic variability

doi:10.3877/cma.j.issn.2095-9605.2020.01.009

Abstract

Abstract:

Objective

To investigate the blood glucose fluctuation level in patients with type 2 diabetes treated with insulin pump during perioperative period.

Methods

Choose between January 2018 and April 2019 in The First Clinical Medical College of Jinan University and application of insulin pump therapy, 126 cases of elective surgical procedures in patients with type 2 diabetes as the research object, using portable blood glucose meter to monitor patients' blood glucose levels, by evaluating the blood sugar level of standard deviation of blood glucose (SDBG), postprandial plasma glycemic excursions (PPGE), largest amplitude of glycemic excursions (LAGE), and other indicators to understand patients blood glucose fluctuations.

Results

The f glycemic variability in 126 patients was above normal, SDBG was (2.81±1.37) mmol/L, PPGE was (4.64±2.66) mmol/L, and LAGE was (7.85±4.06) mmol/L. Compared with postoperative blood glucose fluctuation, preoperative SDBG, PPGE and LAGE were all increased (P<0.05) . The glycemic variability (SDBG, PPGE, LAGE) was the highest on the day of the upper pump, and then gradually decreased until it became stable 1 day after the operation. The glycemic variability rose to the peak again 2~3 days after the operation, and then the glycemic variability gradually decreased and became stable. The incidence of postoperative hypoglycemia was higher than that before surgery (P<0.05).

Conclusions

During the perioperative period, the blood glucose of the patients treated with insulin pump fluctuated greatly, and the fluctuation amplitude showed regular changes. Before the operation, the blood glucose fluctuated greatly-decreased-stabilized; after the operation, the glycemic variability steadily- increased-decreased-stabilized. Therefore, according to the law of glycemic variability, the medical staff should closely monitor the blood glucose changes of patients, timely adjust the dose of insulin, and promote the stable blood glucose control.

Key words: Glycemic variability, Perioperative, Insulin pump, Status quo

Xiaoyu Chen, Jiewei Huang, Yanping Li, Peiru Zhou, Xueyan Liu, yan Zhou, Na Li, Zhiqi Luo. Status and analysis of the patients in perioperative with insulin pump blood glycemic variability[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2020, 06(01): 41-46.

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Figures/Tables 7

References 24

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项目	?
性别（例）	?
男	70
女	56
年龄（岁）	63.49±10.96
糖尿病病程（年）	7.16±6.12
BMI（kg/m²）	23.76±3.81
糖化血红蛋白（%）	9.08±2.04
手术类型（例）	?
脊柱、骨关节手术	45
肾脏及泌尿道手术	21
糖尿病足相关手术	20
胃肠道手术	10
子宫及卵巢手术	8
其他类型手术	22
上泵前空腹血糖（mmol/L）	11.88±4.04
上泵前餐后2 h血糖（mmol/L）	19.35±5.45
应用胰岛素泵持续治疗天数（d）	13.24±6.57

项目	?
性别（例）	?
男	70
女	56
年龄（岁）	63.49±10.96
糖尿病病程（年）	7.16±6.12
BMI（kg/m²）	23.76±3.81
糖化血红蛋白（%）	9.08±2.04
手术类型（例）	?
脊柱、骨关节手术	45
肾脏及泌尿道手术	21
糖尿病足相关手术	20
胃肠道手术	10
子宫及卵巢手术	8
其他类型手术	22
上泵前空腹血糖（mmol/L）	11.88±4.04
上泵前餐后2 h血糖（mmol/L）	19.35±5.45
应用胰岛素泵持续治疗天数（d）	13.24±6.57

项目	SDBG（mmol/L）	PPGE（mmol/L）	LAGE（mmol/L）
脊柱、骨关节手术	1.91±0.30	2.75±0.59	5.29±2.08
肾脏及泌尿道手术	1.70±0.50	2.49±1.00	5.25±1.72
糖尿病足相关手术	1.76±0.57	1.81±0.45	5.46±1.38
胃肠道手术	2.18±0.74	3.31±1.72	6.62±2.06
子宫及卵巢手术	1.59±0.29	2.03±0.84	4.77±1.16
其他类型手术	1.86±0.97	2.25±2.16	5.45±2.97

项目	SDBG（mmol/L）	PPGE（mmol/L）	LAGE（mmol/L）
脊柱、骨关节手术	1.91±0.30	2.75±0.59	5.29±2.08
肾脏及泌尿道手术	1.70±0.50	2.49±1.00	5.25±1.72
糖尿病足相关手术	1.76±0.57	1.81±0.45	5.46±1.38
胃肠道手术	2.18±0.74	3.31±1.72	6.62±2.06
子宫及卵巢手术	1.59±0.29	2.03±0.84	4.77±1.16
其他类型手术	1.86±0.97	2.25±2.16	5.45±2.97

时间	SDBG（mmol/L）	PPGE（mmol/L）	LAGE（mmol/L）
上泵当天	3.44±1.64	5.48±3.36	9.44±4.72
上泵1 d至术前	3.05±1.52	5.29±3.02	8.59±4.67
手术当天	2.67±1.85	5.32±3.36	6.66±4.82
术后1 d	2.53±1.30	4.25±4.00	7.39±3.99
术后2 d	2.79±1.34	4.78±2.70	8.30±4.03
术后3 d	2.88±1.53	4.34±2.41	8.05±4.36
术后4 d	2.74±1.26	4.34±2.72	7.63±3.79
术后5 d	2.84±1.30	4.52±2.47	7.87±3.67
术后6 d	2.55±1.24	4.22±2.43	7.53±3.77
术后7 d	2.52±1.20	4.23±2.61	7.12±3.68

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