Continuous peri-operative glucose monitoring in noncardiac surgery

Article Article scientifique Article Continuous peri-operative glucose monitoring in noncardiac surgery eng 2024-11-07 2025-02-01 author Putzu Alessandro 0000-0002-4943-450X From the Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals (AP, EG, RS, ES), Faculty of Medicine, University of Geneva (ES) and Division of Endocrinology, Diabetes, Nutrition and Therapeutic Patient Education, Department of Medical Specialties, Geneva University Hospitals, Geneva, Switzerland (KG). 989819 author Grange Elliot 696485 author Schorer Raoul 594203 author Schiffer Eduardo 0000-0002-7415-4315 33705 Département d'anesthésiologie, pharmacologie et soins intensifs (APSIC) author Gariani Karim 542849 Département de médecine (DEMED) 162-171 10.1097/EJA.0000000000002095 39512161 0265-0215 PMC11676603 https://journals.lww.com/10.1097/EJA.0000000000002095 Background: Glucose management is an important component of peri-operative care. The usefulness of continuous glucose monitoring (CGM) in noncardiac surgery is uncertain. Objective: To systematically assess the glycaemic profile and clinical outcome of patients equipped with a CGM device during the peri-operative period in noncardiac surgery. Design: Systematic review. Data sources: Electronic databases were systematically searched up to July 2024. Eligibility criteria: Any studies performed in the peri-operative setting using a CGM device were included. Closed-loop systems also administering insulin were excluded. Analyses were stratified according to diabetes mellitus status and covered intra-operative and postoperative data. Outcomes included glycaemic profile (normal range 3.9 to 10.0 mmol l -1 ), complications, adverse events, and device dysfunction. Results: Twenty-six studies (1016 patients) were included. Twenty-four studies were not randomised, and six used a control arm for comparison. In bariatric surgery, diabetes mellitus patients had a mean ± SD glucose of 5.6 ± 0.5 mmol l -1 , with 15.4 ± 8.6% time below range, 75.3 ± 5.5% in range and 9.6 ± 6.7% above range. During major surgery, diabetes mellitus patients showed a mean glucose of 9.6 ± 1.1 mmol l -1 , with 9.5 ± 9.1% of time below range, 56.3 ± 13.5% in range and 30.6 ± 13.9% above range. In comparison, nondiabetes mellitus patients had a mean glucose of 6.4 ± 0.6 mmol l -1 , with 6.7 ± 8.4% time below range, 84.6 ± 15.5% in range and 11.2 ± 4.9% above range. Peri-operative complications were reported in only one comparative study and were similar in CGM and control groups. Device-related adverse events were rare and underreported. In 9.21% of cases, the devices experienced dysfunctions such as accidental removal and issues with sensors or readers. Conclusion: Due to the limited number of controlled studies, the impact of CGM on postoperative glycaemic control and complications compared with point-of-care testing remains unknown. Variability in postoperative glycaemic profiles and a device dysfunction rate of 1 in 10 suggest CGM should be investigated in a targeted surgical group. Glucose management Electronic databases Glucose Dewey 616 Dewey 617 63 Département d'anesthésiologie, pharmacologie, soins intensifs et urgences 229 56 Département de médecine 221 false 1263 MASLD/MASH et résistance à l'insuline 997 47 La médecine périopératoire et l'anesthésie 70 538 Groupe Savoldelli Georges (simulation) 878 European journal of anaesthesiology 42 2 dfb30106-13df-4bea-a3d2-a5cbf304129d Article (Published version) Public continuous_peri_operative_glucose_m.pdf 699150 application/pdf CC BY-4.0 ed8dd938dcef314353cebd88bf7bc97a3cc68b58fb257646441f63bf302d9159 openAccess Faculté de médecine / Section de médecine clinique / Département d'anesthésiologie, pharmacologie, soins intensifs et urgences Faculté de médecine / Section de médecine clinique / Département de médecine

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