Diabetes Notification System to Improve Perioperative Outcomes

Electronic Alerts to Change Standard of Care for Thousands of Diabetic Patients

Washington, D.C. — (October 17, 2012) 

A study presented at the ANESTHESIOLOGY 2012™ annual meeting revealed that adding increased glucose monitoring throughout surgical procedures will allow anesthesiologists to optimize the perioperative and surgical care of millions of diabetic patients throughout the world.

Approximately 17.5 million people in the U.S. have diabetes. These patients are known to have a higher likelihood of undergoing major surgeries than non-diabetic patients, have a higher risk of adverse events during surgery and a 30 to 50 percent longer stay in the hospital post-surgery.

In a recent survey of 269 hospitals across the U.S., one third of respondents indicated they had no metric to track the quality of inpatient diabetes care. Unfortunately, the optimal strategy to manage blood sugar in diabetic patients undergoing surgery is still up for debate, and this study establishes that increased vigilance through perioperative monitoring provides clinicians an important method for greatly improving care for this significant patient population.

“Avoiding extremes in blood glucose values, especially hypoglycemia or low blood sugar, is imperative to ensuring the safety of diabetic patients during surgery,” said study author Jesse M. Ehrenfeld, M.D., M.P.H., Department of Anesthesiology and Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tenn. “This is particularly important for surgical patients because the clinical signs of hypoglycemia can be masked by general anesthesia while patients are unable to communicate with their physicians.”

About the Study
A prospective multicenter trial was launched in which electronic notifications were provided to anesthesia providers during surgery to guide their performance of intraoperative glucose testing. A total of 13,384 patients were enrolled from May 2010 to July 2012. The “Intraoperative Glucose Monitoring Alert” recommended that glucose be measured every hour if insulin was administered during surgery, and every 120 minutes if a diabetic patient was undergoing surgery, but not receiving intraoperative insulin. The following results were measured: the impact of these point-of-care notifications on glucose monitoring, dangerously out-of-range blood sugar values, surgical site infection rates and hospital length of stay.

To date, the results indicate the rate of glucose testing during surgery was greatly improved, and fewer patients had a dangerously abnormal glucose value. Statistically significant reductions in surgical site infections and 14-day readmissions were also observed in the intervention group.

Already, the implementation of intraoperative glucose monitoring notifications have led to an important improvement in surgical care, reduced markedly abnormal glucose values, fewer surgical site infections and reduced hospital readmissions post-surgery.

“The results of this study are likely to change the standard of care for the thousands of diabetic patients who undergo surgical procedures and anesthesia every day,” said Dr. Ehrenfeld.


Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 52,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/WhenSecondsCount. Join the ANESTHESIOLOGYTM 2014 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES2014.



American Society of Anesthesiologists