Incidence and Factors of Hypoglycemia in Perioperative Patients with Type 2 Diabetes Mellitus on Insulin Pump Therapy

Abstract

Objective: To estimate the incidence of and identified factors associated with hypoglycemia among perioperative diabetes patients with insulin pump therapy. Methods: This was a retrospective cohort study of type 2 diabetes patients with insulin pump therapy newly received surgery. All patients were divided into hypoglycemia group and non-hypoglycemia group according to whether they experienced hypoglycemia. Information about clinical characteristics and treatments were collected and compared between two groups. We estimated the incidence of hypoglycemia, and identified factors associated with hypoglycemia by using multivariable logistic regression. Results: A total of 172 episodes of hypoglycemia were observed in 88 (39.8%) patients, among which, 146 (84.9%) were level 1 hypoglycemia (<3.9 mmol/L) and 26 (15.1%) were level 2 (< 3.0 mmol/L). No severe hypoglycemia (level 3) was reported in this study. Results from the multivariable logistic regression model found that diabetes patients with a longer duration of pump use were more likely to have hypoglycemia (AOR=1.09 with 95% CI=1.04-1.15). However, those diabetes patients who were with higher BMI and eGFR were less likely to have hypoglycemia (AOR=0.86 with 95% CI=0.76-0.98; AOR=0.86 with 95% CI=0.76-0.98, respectively). Conclusion: Perioperative diabetes patients with insulin pump therapy were prone to develop mild to moderate hypoglycemia. The long-term of receiving insulin pump therapy during the perioperative period, with lower BMI and eGFR, put type 2 diabetes at higher risks in hypoglycemia. It may help healthcare providers to screen hypoglycemia among type 2 diabetes patients with receiving long-term insulin pump therapy.