Glycemic control to improve post-operative outcomes in patients with type 2 diabetes mellitus: Results of the SUGAR (Surgical Universal euGlycemic Attainment during Recovery) initiative

Objective: Hyperglycemia, or glucose values >180 mg/dL, is associated with adverse post-operative outcomes. Our objective was to determine the impact of improving peri-operative glycemic control and evaluate infectious complications among patients with type 2 diabetes mellitus undergoing open gynecologic surgery. Methods: A multidisciplinary team standardized pre-operative screening, referral algorithms, and intra-operative and post-operative hyperglycemia management (Surgical Universal euGlycemic Attainment during Recovery initiative). We compared outcomes between a baseline cohort (March 2016-December 2017) and an intervention cohort (February 2018-August 2022). Patients with type 1 diabetes, and planned minimally invasive, multi-team, or emergency surgery were excluded. Clinical and demographic characteristics were compared using the χ² test, Fisher exact test, t test, or Wilcoxon rank-sum test, and generalized linear mixed models were used with a logit link function. All statistical analyses were performed using Stata/MP v17.0 (College Station, StataCorp). Results: We assessed 103 baseline patients and 167 intervention patients with diabetes. In the baseline cohort, 26 patients (25%) had hemoglobin A1C screened prior to surgery compared with 158 (95%) in the intervention cohort (p < .001). All surgical patients were screened for diabetes to determine eligibility, and we tracked the rate of patients newly diagnosed with type 2 diabetes (18 patients or 11%). The percentages of glucose values ≤180 mg/dL pre-operatively or intra-operatively were similar between cohorts, but the intervention cohort had increased compliance with assessing glucose intra-operatively (84% compared with 55%, p < .001). The percentage of post-operative glucose values ≤180 mg/dL increased from 77% in the baseline cohort to 86% in the intervention cohort (p = .002). The average post-operative glucose value was 10 mg/dL lower in the intervention cohort than in the baseline cohort (p = .005). Rates of surgical site infection, pneumonia, and urinary tract infection were similar between cohorts. Conclusion: Our initiative improved compliance with pre-operative glycemic screening and decreased hyperglycemia among diabetic patients. We did not identify the correlation between glycemic control and infectious complications.