Intravenous Bolus-infusion Versus Sliding Scale of Insulin for Intra-operative Glycemic Control
Status:
Not yet recruiting
Trial end date:
2022-07-01
Target enrollment:
Participant gender:
Summary
Pre-operative blood glucose (BG) concentrations in type 2 diabetic patients undergoing
elective non-cardiac surgery; have an increased incidence of in-hospital morbidity for
cardiopulmonary and infectious complications. Also, hyperglycemia is associated with
increased production and impaired scavenging of oxygen reactive species, polymorph nuclear
neutrophil dysfunction and decreased intracellular killing, resulting in poor wound healing
and increased risk of infection. Thus, perioperative optimal glucose management contributes
to reduced morbidity and mortality. Recommendations favor moderate levels of capillary blood
glucose (CBG); maintaining it in the range of 140-180 mg/dl.
Peri-operative doses of rapidly acting insulin for glycemic control could be done by the
sliding scale or the bolus-infusion approaches. The sliding scale of insulin is commonly used
to manage peri-operative hyper-glycaemia. It involves administering prescribed doses of
insulin when the CBG is within determined ranges and withholding insulin when the CBG is
within normal range. When used as a sole therapy; it results in under-insulinisation and thus
hyper-glycaemia. The use of a dynamic insulin regimen like the intravenous bolus-infusion
approach; allows adjusting the blood glucose level according to the insulin sensitivity of
each patient, thus, better glucose control and less variations than the intermittent
intravenous bolus of short-acting insulin in the sliding scale despite the same blood glucose
target.