PERIOPERATIVE DIABETES REGULATION WITH THE HELP OF A STANDARD PROTOCOL

According to a standard protocol 115 patients (96 type 2 DM, 19 type 1 DM) were treated with a 3 litre glucose 5%/day infusion, KCl and insu lin, with the aim of obtaining near-normoglycaemia perioperatively. Bl ood glucoses of 6.7-10.0 mmol/l were scored as ideal, 3.5-15.0 mmol/l as acceptable, and the remaining values as unacceptable. In 32 patient s (28%) the protocol was followed in all aspects, whereas in 45 patien ts (39%) the protocol was followed in therapeutic aspects (total n = 7 7.67%, Group 1). In the remaining 38 patients (33%) protocol violation s occurred (Group 2). In 48 patients (62%) of Group 1 ideal or accepta ble control was obtained perioperatively versus 11 patients (29%) of G roup 2 (p < 0.05). In patients with good preoperative long-term regula tion (HbA(1) less than or equal to 8.0%; n = 81) ideal or acceptable p erioperative control was achieved in 58% (n = 47) versus 13% (n = 4) o f those (n = 31) with preoperative HbA, > 8.0% (p < 0.05). Stepwise mu ltiple logistic regression analysis showed that preoperative long-term regulation (HbA(1); p < 0.001) and adherence to the protocol (p = 0.0 22) were the only independent variables with prognostic significance f or perioperative blood glucose control. In 17 patients (15%) minor ele ctrolyte disturbances occurred. No patient had frank ketosis. Duration of disease, presence of complications, type of anaesthesia and operat ion did not affect perioperative diabetes control. It is concluded tha t with a standard protocol, ideal or acceptable perioperative control can be achieved. Good preoperative long-term diabetes regulation also leads to better perioperative control.