Use of an Electronic Health Record–Embedded Glycemic Management Protocol to Improve Perioperative Glucose Control in People With Diabetes

Abstract

Background:

Perioperative hyperglycemia in people with diabetes is associated with increased morbidity, mortality, and health care costs. Despite guideline recommendations to institute interventions to reduce hyperglycemia, standardized protocols that integrate into clinical workflows are lacking. In this article, we evaluate the efficacy of a digitally embedded, glycemic management protocol in people with diabetes undergoing surgery.

Methods:

We conducted a retrospective analysis of a quality improvement study conducted at a tertiary-care academic hospital. Adults with diabetes undergoing noncardiac surgery with more than two hours of procedure time were included. A multidisciplinary protocol was implemented guiding insulin administration and glucose monitoring across preoperative, intraoperative, and post-anesthesia care unit (PACU) phases. People undergoing surgery during one year before protocol implementation were compared with those in the year after. The primary outcome was the proportion of intraoperative glucose readings within 70 to 180 mg/dL. Secondary outcomes included glucose control in other perioperative phases, hypoglycemia incidence, and 30-day postoperative complications.

Results:

Among 1254 adults (634 pre-intervention, 620 post-intervention), the mean proportion of intraoperative glucose values in the target range of 70 to 180 mg/dL showed a modest yet statistically significant improvement after protocol implementation (0.65 vs 0.72, P = .021). We found a reduced risk of hypoglycemia in the preoperative phase (3.7% vs 1.3%, P = .007) and no increased risk of hypoglycemia in the intraoperative or PACU phases. An increase in glucose monitoring and intravenous insulin use was noted across all phases of care (P < .001).

Conclusions:

Implementation of a digitally embedded perioperative glycemic management protocol improved glucose monitoring and intraoperative glucose control without increasing hypoglycemia. These findings support the safe and effective use of the protocol across surgical specialties and case urgencies, supporting the value of integrating decision support tools into clinical workflows.