December 11, 2019
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Postoperative infections less frequent with insulin pump therapy for adults with diabetes

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Adults with diabetes who undergo surgery may be less likely to develop an infection and spend less time in the hospital after an operation if they are treated with continuous subcutaneous insulin infusion instead of insulin injection therapy, according to findings published in the Journal of Diabetes.

“Continuous subcutaneous insulin infusion has better control of glucose, lower risk of postoperative infection and shorter hospital stay, which suggests that continuous subcutaneous insulin infusion therapy might improve postoperative life quality of patients and their postoperative prognosis,” Xuefeng Yu, MD, PhD, of the division of endocrinology in the department of internal medicine at Tongji Hospital, Tongji Medical College and Huazhong University of Science and Technology in China, and colleagues wrote. “Continuous subcutaneous insulin infusion is, therefore, a good choice for perioperative patients, especially when blood glucose is severely elevated and difficult to control.”

Using medical records from January 2006 to March 2016 at Tongji Hospital, Yu and colleagues evaluated fasting and mean glucose levels across 8 days, with surgery performed on the third day, in 253 adults with diabetes who were treated with continuous subcutaneous insulin infusion (CSII; mean age, 58.7 years; 49.8% women) and 253 propensity-matched adults who were treated with insulin injection therapy (mean age, 58.49 years; 45.5% women). The researchers also assessed how often participants had fevers, whether they took antibiotics, their positive rates of bacterial cultures and how long they were in the hospital.

Diabetes insulin male 2019 
Adults with diabetes who undergo surgery may be less likely to develop an infection and spend less time in the hospital after an operation if they are treated with continuous subcutaneous insulin infusion instead of insulin injection therapy.
Source: Adobe Stock

Average fasting glucose was 7.67 mmol/L among those on CSII and 8.34 mmol/L among those on insulin injection therapy (P < .001). Mean glucose was 9.22 mmol/L among those on CSII and 10.22 mmol/L among those on injections (P < .001).

Effect on infection factors

On the day of surgery, fevers occurred among 10.2% of those on CSII and 18.6% of those on injections (P = .014). On the day after surgery, fevers occurred among 34.7% of the CSII group and 55.1% of the injection group (P < .001).

The positive rate of secretion culture was 1.2% among those on CSII and 7.5% among those on injections (P = .001).

The CSII group required antibiotics for an average of 10.23 days total and 8.72 days after surgery vs. 12.46 days total (P = .002) and 10.34 days after surgery (P < .001) for the injection group.

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It took 11 days on average before health care providers could take out the suture for the CSII group and 13.64 days for the injection group (P = .01).

“These results suggest that CSII therapy reduces the risk of postoperative infection,” the researchers wrote. “Furthermore, patients in the CSII group also needed fewer days until suture removal, which indicates that CSII therapy could shorten the time needed for surgical site healing and improve the prognosis of patients.”

Time, costs

Participants on CSII spent an average of 19.05 days in the hospital, including 10.7 days after surgery, whereas participants on insulin injection therapy spent an average of 21.83 days in the hospital, including 12.71 days after surgery (P < .001 for both). The researchers noted that those on CSII and those on insulin injection therapy spent similar amounts on medical expenses.

“Although the cost of CSII therapy was higher than other insulin treatments, we did not observe a significant difference in the total hospital expenditure between the CSII group and non-CSII group,” the researchers wrote. “A probable explanation is that CSII therapy reduced other medical costs via improved postoperative outcomes and shortened hospital stay.” – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.