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
