Glycemic control to improve post-operative outcomes in patients with type 2 diabetes mellitus: Results of the SUGAR (Surgical Universal euGlycemic Attainment during Recovery) initiative

Abstract

Objective: Hyperglycemia, or glucose values >180 mg/dL, is associated with adverse post-operative outcomes. Our objective was to determine the impact of improving peri-operative glycemic control and evaluate infectious complications among patients with type 2 diabetes mellitus undergoing open gynecologic surgery. Methods: A multidisciplinary team standardized pre-operative screening, referral algorithms, and intra-operative and post-operative hyperglycemia management (Surgical Universal euGlycemic Attainment during Recovery initiative). We compared outcomes between a baseline cohort (March 2016-December 2017) and an intervention cohort (February 2018-August 2022). Patients with type 1 diabetes, and planned minimally invasive, multi-team, or emergency surgery were excluded. Clinical and demographic characteristics were compared using the χ2 test, Fisher exact test, t test, or Wilcoxon rank-sum test, and generalized linear mixed models were used with a logit link function. All statistical analyses were performed using Stata/MP v17.0 (College Station, StataCorp). Results: We assessed 103 baseline patients and 167 intervention patients with diabetes. In the baseline cohort, 26 patients (25%) had hemoglobin A1C screened prior to surgery compared with 158 (95%) in the intervention cohort (p