Florence Ho, Mervyn Kyi, Spiros Fourlanos, Peter G. Colman, Leon J. Worth, Rahul D. Barmanray
{"title":"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）。","authors":"Florence Ho, Mervyn Kyi, Spiros Fourlanos, Peter G. Colman, Leon J. Worth, Rahul D. Barmanray","doi":"10.1111/dme.70370","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Aims</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>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.</p>\n </section>\n </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"43 8","pages":""},"PeriodicalIF":3.3000,"publicationDate":"2026-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70370","citationCount":"0","resultStr":"{\"title\":\"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)\",\"authors\":\"Florence Ho, Mervyn Kyi, Spiros Fourlanos, Peter G. Colman, Leon J. Worth, Rahul D. Barmanray\",\"doi\":\"10.1111/dme.70370\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Aims</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>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.</p>\\n </section>\\n </div>\",\"PeriodicalId\":11251,\"journal\":{\"name\":\"Diabetic Medicine\",\"volume\":\"43 8\",\"pages\":\"\"},\"PeriodicalIF\":3.3000,\"publicationDate\":\"2026-07-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70370\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Diabetic Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/dme.70370\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2026/5/21 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"ENDOCRINOLOGY & METABOLISM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Diabetic Medicine","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/dme.70370","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/5/21 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
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)
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.
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.”
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