Continuous insulin infusion versus sliding scale for perioperative glycemic control in diabetic patients undergoing elective hip arthroplasty

Abstract

Background: The incidence of diabetes mellitus (DM) in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) is as high as 52%. The aim of this work was to compare between continuous insulin infusion method versus sliding scale method in glycemic control and decreasing the rate of postoperative wound infection in diabetic patients undergoing elective hip arthroplasty.Methods: This prospective randomized controlled trial was carried out on 40 patients aged from 35 to 70 years old, both sexes, diagnosed with type II diabetes underwent American society of anesthesiologists (ASA) II or III who subjected to elective hip arthroplasty. Subjects were allocated into two equal groups. Group C (control group): subjected to sliding scale and Group P (protocol group): subjected to insulin infusion in a concentration of 100U insulin on 100mL of normal saline and if there was no response to initial dose of insulin or still measurements were higher than preset range, doses were doubled.Results: There was significant decrease in the random blood sugar measurements in group P who were subjected to insulin infusion than group C who subjected to sliding insulin scale at 1, 2, 3 and 4 hours follow up during surgery (p˂ 0.001). As regard intraoperative heart rate (HR), mean arterial pressure (MAP), follow-up, there was non-statistically significant difference between both studied groups regarding subsequent HR measurements prior surgery start (baseline), and at 15, 30, 45.60, 90, 120, 150, 180, 210 and 240 minutes. All measurements were slightly higher in group C, but the difference was not statistically significant (p> 0.05).