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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

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.

Anaes-thesia Critical Care & Pain Medicine, Elsevier Masson, 2018, 37 (Supplement 1), pp.S37-S38.

�10.1016/j.accpm.2017.10.009�. �hal-02621853�

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Guidelines

Perioperative

management

of

adult

diabetic

patients.

The

role

of

the

diabetologist

Gae¨lle

Cheisson

a

,

Sophie

Jacqueminet

b,c

,

Emmanuel

Cosson

d,e

,

Carole

Ichai

f,g

,

Anne-Marie

Leguerrier

h

,

Bogdan

Nicolescu-Catargi

i

,

Alexandre

Ouattara

j,k

,

Igor

Tauveron

l,m,n,o

,

Paul

Valensi

d

,

Dan

Benhamou

a,

*

,

working

party

approved

by

the

French

Society

of

Anaesthesia

and

Intensive

Care

Medicine

(SFAR)

and

the

French

Society

for

the

study

of

Diabetes

(SFD)

a

Anaesthesiaandintensivecaredepartment,hoˆpitauxuniversitairesParis-Sud,AP–HP,hoˆpitaldeBiceˆtre,78,rueduGe´ne´ral-Leclerc,94275Le Kremlin-Biceˆtre,France

b

Heartmetabolismandnutritioninstitute,AP–HP,hoˆpitaldelaPitie´-Salpeˆtrie`re,75013Paris,France

cDepartmentofdiabetesandmetabolicdiseases,hoˆpitaldelaPitie´-Salpeˆtrie`re,75013Paris,France

dCRNH-IdF,CINFO,endocrinology–diabetology–nutritiondepartment,hoˆpitalJean-Verdier,AP–HP,universite´ Paris13,SorbonneParisCite´,93140Bondy,

France

e

Inserm,UMRU1153,U1125INRA/CNAM,SorbonneParisCite´,universite´ Paris13,93000Bobigny,France

f

Polyvalentintensivecaredepartment,hoˆpitalPasteur2,CHUdeNice,30,voieRomaine,06001Nicecedex1,France

g

IRCAN(InsermU1081,CNRSUMR7284),UniversityHospitalofNice,06001Nice,France

h

Endocrinologyanddiabetologydepartment,CHUdeRennes,CHUhoˆpitalSud,16,boulevarddeBulgarie,35056Rennes,France

iMetabolicdiseasesandendocrinologydepartment,hoˆpitalSaint-Andre´,CHUdeBordeaux,1,rueJean-Burguet,33000Bordeaux,France jCHUdeBordeaux,departmentofanaesthesiaandcriticalcareII,Magellanmedico-surgicalcenter,33000Bordeaux,France

k

Inserm,UMR1034,Universite´ Bordeaux,biologyofcardiovasculardiseases,33600Pessac,France

l

Endocrinologyanddiabetologydepartment,CHUdeClermont-Ferrand,58,rueMontalembert,63000Clermont-Ferrand,France

m

UFRme´decine,universite´ Clermont-Auvergne,28,placeHenri-Dunant,63000Clermont-Ferrand,France

n

InsermU1103,UMRCNRS6293,ge´ne´tiquereproductionetde´veloppement,universite´ Clermont-Auvergne,63170Aubie`re,France

o

Endocrinologyanddiabetologydepartment,CHUG.-MontpiedBP69,63003Clermont-Ferrand,France

1. Howdoweviewtheroleofthediabetologist?

Several studies have highlighted the beneficial effects of referringapatienttoadiabetologist intheperioperativeperiod (before,duringandafterhospitalisation),asseekingaconsultation offerstheopportunitytooptimisetreatmentaswellastoinitiate, update or complete the education of the patient regarding managementofhis(her)disease.

In the preoperative period, the general practitioner or the anaesthetistshouldask a diabetologist for adviceifdiabetes is detectedorif,inaknowndiabetic,significantglycaemicimbalance

isobserved,i.e.frequentorasymptomatichypoglycaemicepisodes (HbA1c<5%),meanbloodsugarlevel>1.80g/L(10mmol/L)or HbA1c>8%.Anintensificationoftreatmentisthennecessaryto 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 thattherapeuticmanagementbyadiabetologistduring hospita-lisation, not directly linked to the diabetes, leads to better glycaemiccontrol[1],fewerhospitalisationsfordiabetes[1,2],a reduction of the duration of hospitalisation [2] and lower healthcare costs[2]. Forexample,in diabeticpatients admitted tothehospitalforreasonsotherthandiabetes,consultationwitha diabetologistreducedthemeandurationofstayfrom8.2daysto

AnaesthCritCarePainMed37(2018)S37–S38

ARTICLE INFO

Articlehistory:

Availableonline6January2018

Keywords: Diabetes Perioperative HbA1c Diabetologist Glycaemicimbalance ABSTRACT

Apatientshouldbereferredtoadiabetologistperioperativelyinseveralcircumstances:preoperative recognitionofapreviouslyunknowndiabetesordetectionofglycaemicimbalance(HbA1c<5%or >8%); during hospitalisation,recognition of a previously unknown diabetes,persisting glycaemic imbalancedespitetreatmentordifficultyresumingpreviouslyusedchronictreatment;postoperatively andafterdischargefromhospital,foralldiabeticpatientsinwhomHbA1cis>8%.

C 2018TheAuthors.PublishedbyElsevierMassonSASonbehalfofSocie´te´ franc¸aised’anesthe´sieetde

re´animation(Sfar).ThisisanopenaccessarticleundertheCCBYlicense(http://creativecommons.org/

licenses/by/4.0/).

* Correspondingauthor.

E-mailaddress:dan.benhamou@aphp.fr(D.Benhamou).

https://doi.org/10.1016/j.accpm.2017.10.009

2352-5568/ C2018TheAuthors.PublishedbyElsevierMassonSASonbehalfofSocie´te´ franc¸aised’anesthe´sieetdere´animation(Sfar).Thisisanopenaccessarticleunderthe

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5.5 days [3].It is necessarytoask a diabetologist for adviceif diabetes is discovered during hospitalisation or if glycaemic imbalance is demonstrated by blood sugar levels >2g/L (11mmol/L),HbA1c>9%orifthepatienthasdifficultiesrestarting previoustreatment.

2. Overall

It is advisable to refer a patient to a diabetologist in the followingsituations:

 knowndiabeteswithpreoperativeglycaemicimbalance(HbA1c <5%or>8%);

 diabetes discovered during hospitalisation or during the anaesthesiaconsultation;

 diabetes with glycaemic imbalance during hospitalisation (HbA1c>9%)ordifficultyresumingprevioustreatment;  bloodsugar level >3g/L (16.5mmol/L) during ambulatorysurgery;  afterthepatienthaslefthospitalforalldiabeticpatientswith

HbA1c>8%.

Disclosureofinterest

Theauthorsdeclarethattheyhavenocompetinginterest. Acknowledgements

Themembersoftheworkingpartyhavereceivedsupportfrom theFrench Society of Anaesthesiaand IntensiveCare Medicine (SFAR)andtheFrenchSocietyfortheStudyofDiabetes(SFD)for transportandaccommodationwhennecessary.Thetwonational bodieshavealsoprovidedhonorariafortranslationofthetexts.

References

[1]KoproskiJ,PrettoZ,PoretskyL.Effectsofaninterventionbyadiabetesteamin hospitalizedpatientswithdiabetes.DiabetesCare1997;20:1553–5.

[2]LevetanCS,PassaroMD,JablonskiKA,RatnerRE.Effectofphysicianspecialtyon outcomesindiabeticketoacidosis.DiabetesCare1999;22:1790–5.

[3]LevetanCS,SalasJR,WiletsIF,ZumoffB.Impactofendocrineanddiabetesteam consultationonhospitallengthofstayforpatientswithdiabetes.AmJMed 1995;99:22–8.

G.Cheissonetal./AnaesthCritCarePainMed37(2018)S37–S38 S38

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