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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�
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
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