Glucose management team significantly improves glycaemic care and commitment to in‐hospital guidelines within arthroplastic patients

Abstract

Perioperative dysglycaemias are a risk for harm but guidelines to improve glucose management are poorly adhered to. To determine whether a specialized team and diabetes education improves the implementation of guidelines and glucose values. We conducted a prospective study of 611 nonselected, consecutive patients attending for elective hip or knee arthroplasty. The first 209 patients received conventional care and the following 402 patients received intervention (Acute Glucose Service, AGS) in two chronological groups; either perioperatively (AGS1) or also preoperatively (AGS2). The AGS-team provided diabetes education, identified the patients with diabetes risk and adjusted the medication when needed. Capillary plasma glucose (CPG) was repeatedly measured and glycated haemoglobin (HbA1c) obtained before and after the surgery. The study objectives were to evaluate the staff actions when hyperglycaemia was severe (CPG >10mmol/L), and to assess improvement of the glycaemic values and the complication rate within 3months. None of the severely hyperglycaemic events in the reference group were treated according to guidelines. In the AGS 1group, 50% and in the AGS2group, 53% were appropriately managed (p<.001). The events of hyperglycaemia (CPG >7.8mmol/L at least twice) and of severe hyperglycaemia (CPG >10mmol/L) decreased in all patient groups. The medians of the highest, mean and variability of CPG values improved. The mean HbA1c improved significantly within AGS 2. There was no association between improved glycaemic care and early complications. AGS intervention significantly improves adherence to guidelines and glucose values.