A retrospective sub-study of perioperative glycaemia and insulin treatment for hospital inpatients at a quaternary centre from the specialist treatment of inpatients: Caring for diabetes in surgery trial (STOIC-D Surgery)

IF 3.3 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Diabetic Medicine Pub Date : 2026-07-18 Epub Date: 2026-05-21 DOI:10.1111/dme.70370

Florence Ho, Mervyn Kyi, Spiros Fourlanos, Peter G. Colman, Leon J. Worth, Rahul D. Barmanray

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Abstract

Aims

Surgical inpatients experience variable glycaemia, with hyper and hypoglycaemia, contributing towards increased morbidity and mortality. Understanding of mechanisms for glycaemic variability and clinician responses remains limited. We aimed to describe patterns of glycaemia in the immediate perioperative period and its drivers, including treatment with glucose-lowering agents.

Methods

This was a sub-analysis of participants in the STOIC-D Surgery trial, a randomised controlled trial of early specialist-led glycaemic management for inpatients with pre-admission diabetes or inpatient hyperglycaemia. Patients in this sub-study underwent at least one procedure during admission. Data from day prior to surgery, day of surgery and day after surgery were collected, including blood glucose levels and factors influencing glycaemia.

Results

518 participants were included, with a mean HbA1c of 52 mmol/mol (6.9%). 295 (57%) patients received insulin during the three perioperative days; 130 (44%) of these insulin-receiving patients had a consistent increase in their total daily insulin dose across the 3 days. These patients had the highest perioperative glycaemia compared to patients with different insulin titration trends, particularly on the day of and day after surgery. Fasting duration was the only variable identified as being significantly associated with increased postoperative glycaemia. Hypoglycaemia was uncommon, occurring in 3% of all patients for each perioperative day. This was higher for patients receiving perioperatively insulin.

Conclusions

This study characterised perioperative glycaemia trends and suggests that clinicians identify patients who require intensification of insulin treatment in the perioperative period, which needs to be counterbalanced with the risk of hypoglycaemia.

Abstract Image

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第四中心住院患者专科治疗围手术期血糖和胰岛素治疗的回顾性亚研究：手术中糖尿病护理试验（STOIC-D surgery）。

目的：外科住院患者经历可变血糖，高血糖和低血糖，导致发病率和死亡率增加。对血糖变异性的机制和临床反应的了解仍然有限。我们的目的是描述围手术期的血糖模式及其驱动因素，包括降糖药的治疗。方法：这是一项对STOIC-D手术试验参与者的亚分析，STOIC-D手术试验是一项随机对照试验，针对入院前糖尿病或住院高血糖患者进行早期专家主导的血糖管理。该亚研究的患者在入院期间至少接受了一次手术。收集手术前一天、手术当天和手术后一天的数据，包括血糖水平和影响血糖的因素。结果：纳入518名参与者，平均HbA1c为52 mmol/mol（6.9%）。295例（57%）患者在围手术期3天内接受胰岛素治疗；在接受胰岛素治疗的患者中，有130人（44%）在3天内的每日总胰岛素剂量持续增加。与胰岛素滴入趋势不同的患者相比，这些患者的围手术期血糖最高，尤其是在手术当天和术后一天。禁食时间是唯一被确定与术后血糖升高显著相关的变量。低血糖不常见，围手术期每天的低血糖发生率为3%。在围手术期接受胰岛素治疗的患者中，这一比例更高。结论：本研究描述了围手术期血糖趋势，并建议临床医生识别需要在围手术期加强胰岛素治疗的患者，这需要与低血糖的风险相平衡。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetic Medicine 医学-内分泌学与代谢

CiteScore

7.20

自引率

5.70%

发文量

229

审稿时长

3-6 weeks

期刊介绍： Diabetic Medicine, the official journal of Diabetes UK, is published monthly simultaneously, in print and online editions. The journal publishes a range of key information on all clinical aspects of diabetes mellitus, ranging from human genetic studies through clinical physiology and trials to diabetes epidemiology. We do not publish original animal or cell culture studies unless they are part of a study of clinical diabetes involving humans. Categories of publication include research articles, reviews, editorials, commentaries, and correspondence. All material is peer-reviewed. We aim to disseminate knowledge about diabetes research with the goal of improving the management of people with diabetes. The journal therefore seeks to provide a forum for the exchange of ideas between clinicians and researchers worldwide. Topics covered are of importance to all healthcare professionals working with people with diabetes, whether in primary care or specialist services. Surplus generated from the sale of Diabetic Medicine is used by Diabetes UK to know diabetes better and fight diabetes more effectively on behalf of all people affected by and at risk of diabetes as well as their families and carers.”