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Exp Clin Endocrinol Diabetes 2024; 132(03): 142-151
DOI: 10.1055/a-2218-4574
Article

Perioperative Insulin Pump Therapy Decreases Readmission Risk and Improves Outcomes in Patients with Diabetes

Kun Wang   †
1   The First Affiliated Hospital of Hainan Medical University, Hainan Clinical Research Center for Metabolic Disease, Haikou, Hainan, China
2   Nursing College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China
,
Fang Bai   †
1   The First Affiliated Hospital of Hainan Medical University, Hainan Clinical Research Center for Metabolic Disease, Haikou, Hainan, China
,
Xiaopan Chen
1   The First Affiliated Hospital of Hainan Medical University, Hainan Clinical Research Center for Metabolic Disease, Haikou, Hainan, China
,
Joshua D. Miller
3   Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
,
Xue Chen
4   Jiangsu College of Nursing, Huaian, Jiangsu, China
,
Chuan Yun
1   The First Affiliated Hospital of Hainan Medical University, Hainan Clinical Research Center for Metabolic Disease, Haikou, Hainan, China
,
Zhenzhen Sun
2   Nursing College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China
,
Xiaodan Yuan
5   Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China
,
Qingqing Lou 
1   The First Affiliated Hospital of Hainan Medical University, Hainan Clinical Research Center for Metabolic Disease, Haikou, Hainan, China
› Author Affiliations Funding This study was supported in part by grants from Cadre Health Care in Jiangsu Province (BJ18031). This project supported by Hainan Province Clinical Medical Center.
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Abstract

Objective To evaluate the impact of temporary insulin pump use during hospitalization on glycemia, postoperative complications, and cost/utilization in perioperative patients with diabetes.

Methods Patients (n=159) with type 2 diabetes and hospitalized for elective surgery were recruited from three hospitals. Subjects were categorized into the insulin pump group and the multiple daily subcutaneous insulin injection group according to their treatment therapy. Data were collected at admission, discharge, and 3 months post-discharge.

Results Subjects in the CSII group who were still on insulin therapy transitioned from CSII to MDII; however, their daily insulin dosages were lower than those in the MDII group (15.31±10.98 U/d vs. 23.48±17.02 U/d, P=0.015) after discharge. In terms of medical costs, the CSII group had significantly higher hospitalization costs than the MDII group (112.36±103.43 thousand RMB vs. 82.65±77.98 thousand RMB, P=0.043). After 3 months, the CSII group had significantly lower outpatient costs than the MDII group (3.17±0.94 thousand RMB vs. 3.98±1.76 thousand RMB, P ˂ 0.001). In the MDII group, 10 patients reported severe postoperative complications requiring re-hospitalization; there were no similar reports in the CSII group.

Conclusion Temporary use of insulin pump therapy for perioperative patients with diabetes results in a reduction in blood glucose and blood glucose fluctuation during hospitalization, HbA1c, and the risk of postoperative complication and readmission, thus significantly decreasing costs in this complex patient cohort. Further work is needed to better understand indications for utilizing pump therapy based on diabetes phenotype and the complexity of planned surgical intervention.

Key words

insulin pump - multiple daily subcutaneous insulin injection - perioperative insulin pump therapy

† Kun Wang and Fang Bai served as co-first authors (same contribution).




Publication History

Received: 06 June 2023
Received: 13 November 2023

Accepted: 14 November 2023

Article published online:
16 February 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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