Education and Training Prizes

Peri-operative capillary blood glucose monitoring in diabetic patients undergoing general anaesthesia

Authors: TrinoCruz Cervera, Maeve Curran, Jeffrey Chit Wong

Background

ØDiabetes is becoming an overwhelmingly common comorbidity in the peri-operative setting with 1015% of patients presenting for surgery having diabetes, equalling to over 323,000 patients per year, nationally [1]. Diabetes patients are at risk of having a longer term infective and non-infective complications [2]. Poor glycaemic control is therefore essential and will also help to reduce the overall disease management cost. Consequently, it was important to assess our compliance with local and national guidelines [1].

Results

6-12mmol/l

Methods

ØData was collected retrospectively, 250 patients were reviewed, 38 of which were eligible, diabetic patients undergoing general anaesthesia for a surgical procedure. The standards applied were set by the Joint British Diabetes Societies for Inpatient Care, and included capillary blood glucose percentage of time that diabetic patients have their peri-operative CBG between 6mmol/l and 12mmol/l (target 100%) [1]. Management of patients with CBG outside the desired range was also recorded.

1.Centre for perioperative care; Guideline for Perioperative Care for People with Diabetes Mellitus Undergoing Elective and Emergency Surery, March 2021

2.Klein, A.A, Meek, T., Allcock, E., Cook, T.M., Mincher, N., Morris, C., Nimmo, A.F., Pandit, J.J., Pawa, A., Rodney, G. and Sheraton, T., 2021. Recommendations for standards of monitoring during anaesthesia and recovery 2021: Guideline from the Association of Anaesthetists. Anaesthesia.

ØCBG was measured appropriately in 32% of patients in theatre and in 58% of patients in PACU. CBG was maintained within the appropriate range in 50% of patients; however in 21% of cases CBG was not documented. From those patients with CBG outside of the appropriate range (612mmol/l), three required starting of a variable rate insulin infusion (VRII) and one required hypoglycaemic treatment. Four patients were discharged from PACU with CBG outside of this range.

Discussion

Ø There was an overall poor adherence to CBG monitoring, particularly in theatre, although this may also be due to poor documentation. Two of the patients from PACU with a CBG >18mmol/l were not managed prior to discharge, these will be reviewed. After discussion, we have recommended several changes including; review of guidelines at clinical governance meetings, adding ‘is the patient diabetic? and has CBG been monitored?’ to the sign in or sign out checklist in theatre, implementing and consolidating discharge criteria from PACU and making these known via email, teaching and local posters. Increasing the availability of CBG and ketone monitoring devices should also be explored. We expect that these changes will improve perioperative CBG monitoring and we will be re-auditing in the following months.