# Perioperative management of adult diabetic patients.
The role of the diabetologist

Gaelle Cheisson, Sophie Jacqueminet, Emmanuel Cosson, Carole Ichai,
Anne-Marie Leguerrier, Bogdan Nicolescu-Catargi, Alexandre Ouattara, Igor
Tauveron, Paul Valensi, Dan Benhamou

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To cite this version:

Gaelle Cheisson, Sophie Jacqueminet, Emmanuel Cosson, Carole Ichai, Anne-Marie Leguerrier, et al. Perioperative management of adult diabetic patients. The role of the diabetologist. Anaesthesia Critical Care & Pain Medicine, 2018, 37 (Supplement 1), pp.S37-S38. 10.1016/j.accpm.2017.10.009. hal-02621853

HAL Id: hal-02621853

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Guidelines

# Perioperative management of adult diabetic patients. The role of the diabetologist

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CrossMark

Gaëlle Cheisson<sup>a</sup>, Sophie Jacquemin<sup>b,c</sup>, Emmanuel Cosson<sup>d,e</sup>, Carole Ichai<sup>f,g</sup>, Anne-Marie Leguerrier<sup>h</sup>, Bogdan Nicolescu-Catargi<sup>i</sup>, Alexandre Ouattara<sup>j,k</sup>, Igor Tauveron<sup>l,m,n,o</sup>, Paul Valensi<sup>d</sup>, Dan Benhamou<sup>a,\*</sup>, working party approved by the French Society of Anaesthesia and Intensive Care Medicine (SFAR) and the French Society for the study of Diabetes (SFD)

## ARTICLE INFO

Article history:

Available online 6 January 2018

Keywords:

Diabetes

Perioperative

HbA1c

Diabetologist

Glycaemic imbalance

## ABSTRACT

A patient should be referred to a diabetologist perioperatively in several circumstances: preoperative recognition of a previously unknown diabetes or detection of glycaemic imbalance (HbA1c < 5% or > 8%); during hospitalisation, recognition of a previously unknown diabetes, persisting glycaemic imbalance despite treatment or difficulty resuming previously used chronic treatment; postoperatively and after discharge from hospital, for all diabetic patients in whom HbA1c is > 8%.

© 2018 The Authors. Published by Elsevier Masson SAS on behalf of Société française d'anesthésie et de réanimation (Sfar). This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

## 1. How do we view the role of the diabetologist?

Several studies have highlighted the beneficial effects of referring a patient to a diabetologist in the perioperative period (before, during and after hospitalisation), as seeking a consultation offers the opportunity to optimise treatment as well as to initiate, update or complete the education of the patient regarding management of his (her) disease.

In the preoperative period, the general practitioner or the anaesthetist should ask a diabetologist for advice if diabetes is detected or if, in a known diabetic, significant glycaemic imbalance

is observed, i.e. frequent or asymptomatic hypoglycaemic episodes (HbA1c < 5%), mean blood sugar level > 1.80 g/L (10 mmol/L) or HbA1c > 8%. An intensification of treatment is then necessary to improve glycaemic control and reduce the risk of surgical complications.

During the hospital stay, therapeutic management by a diabetologist also appears to be beneficial. It has been shown that therapeutic management by a diabetologist during hospitalisation, not directly linked to the diabetes, leads to better glycaemic control [1], fewer hospitalisations for diabetes [1,2], a reduction of the duration of hospitalisation [2] and lower healthcare costs [2]. For example, in diabetic patients admitted to the hospital for reasons other than diabetes, consultation with a diabetologist reduced the mean duration of stay from 8.2 days to

<footnote><sup>a</sup> Anaesthesia and intensive care department, hôpitaux universitaires Paris-Sud, AP-HP, hôpital de Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France</footnote>

<footnote><sup>b</sup> Heart metabolism and nutrition institute, AP-HP, hôpital de la Pitié-Salpêtrière, 75013 Paris, France</footnote>

<footnote><sup>c</sup> Department of diabetes and metabolic diseases, hôpital de la Pitié-Salpêtrière, 75013 Paris, France</footnote>

<footnote><sup>d</sup> CRNH-IdF, CINFO, endocrinology–diabetology–nutrition department, hôpital Jean-Verdier, AP-HP, université Paris 13, Sorbonne Paris Cité, 93140 Bondy, France</footnote>

<footnote><sup>e</sup> Inserm, UMR 1153, U125 INRA/CNAM, Sorbonne Paris Cité, université Paris 13, 93000 Bobigny, France</footnote>

<footnote><sup>f</sup> Polyvalent intensive care department, hôpital Pasteur 2, CHU de Nice, 30, voie Romaine, 06001 Nice cedex 1, France</footnote>

<footnote><sup>g</sup> IRCAN (Inserm U1081, CNRS UMR 7284), University Hospital of Nice, 06001 Nice, France</footnote>

<footnote><sup>h</sup> Endocrinology and diabetology department, CHU de Rennes, CHU hôpital Sud, 16, boulevard de Bulgarie, 35056 Rennes, France</footnote>

<footnote><sup>i</sup> Metabolic diseases and endocrinology department, hôpital Saint-André, CHU de Bordeaux, 1, rue Jean-Burguet, 33000 Bordeaux, France</footnote>

<footnote><sup>j</sup> CHU de Bordeaux, department of anaesthesia and critical care II, Magellan medico-surgical center, 33000 Bordeaux, France</footnote>

<footnote><sup>k</sup> Inserm, UMR 1034, Université Bordeaux, biology of cardiovascular diseases, 33600 Pessac, France</footnote>

<footnote><sup>l</sup> Endocrinology and diabetology department, CHU de Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France</footnote>

<footnote><sup>m</sup> UFR médecine, université Clermont-Auvergne, 28, place Henri-Dunant, 63000 Clermont-Ferrand, France</footnote>

<footnote><sup>n</sup> Inserm U1103, UMR CNRS 6293, génétique reproduction et développement, université Clermont-Auvergne, 63170 Aubière, France</footnote>

<footnote><sup>o</sup> Endocrinology and diabetology department, CHU G.-Montpied BP 69, 63003 Clermont-Ferrand, France</footnote>

<footnote>* Corresponding author.</footnote>

<footnote>E-mail address: dan.benhamou@aphp.fr (D. Benhamou).</footnote>
5.5 days [3]. It is necessary to ask a diabetologist for advice if diabetes is discovered during hospitalisation or if glycaemic imbalance is demonstrated by blood sugar levels > 2 g/L (11 mmol/L), HbA1c > 9% or if the patient has difficulties restarting previous treatment.

## 2. Overall

It is advisable to refer a patient to a diabetologist in the following situations:

* known diabetes with preoperative glycaemic imbalance (HbA1c < 5% or > 8%);

* diabetes discovered during hospitalisation or during the anaesthesia consultation;

* diabetes with glycaemic imbalance during hospitalisation (HbA1c > 9%) or difficulty resuming previous treatment;

* blood sugar level > 3 g/L (16.5 mmol/L) during ambulatory surgery;

* after the patient has left hospital for all diabetic patients with HbA1c > 8%.

## Disclosure of interest

The authors declare that they have no competing interest.

## Acknowledgements

The members of the working party have received support from the French Society of Anaesthesia and Intensive Care Medicine (SFAR) and the French Society for the Study of Diabetes (SFD) for transport and accommodation when necessary. The two national bodies have also provided honoraria for translation of the texts.

## References

[1] Koproski J, Pretto Z, Poretsky L. Effects of an intervention by a diabetes team in hospitalized patients with diabetes. Diabetes Care 1997;20:1553–5.

[2] Levetan CS, Passaro MD, Jablonski KA, Ratner RE. Effect of physician specialty on outcomes in diabetic ketoacidosis. Diabetes Care 1999;22:1790–5.

[3] Levetan CS, Salas JR, Wilets IF, Zumoff B. Impact of endocrine and diabetes team consultation on hospital length of stay for patients with diabetes. Am J Med 1995;99:22–8.