Giving Nondiabetics Insulin Reduces Infection Risk?

Now, this is an interesting study.  The link between perioperative hyperglycemia and postoperative complications has been described in the literature for a while.  And, as this particular team of researchers are suggesting, it can actually be worse in nondiabetic patients than diabetic patients.

Their study, which was conducted at Bayhealth Medical Center in Dover, Delaware, is the subject of a new paper; “Postoperative Hyperglycemia in Patients with and without Diabetes After Major Joint Replacement: The Impact of an Enhanced Glucose Management Program,” which appears in the July-September 2021 edition of JBJS Open Access.

“High blood glucose after surgery can increase infection risk because the elevated glucose impairs the immune response,” said co-author John Mannion, M.D. to OTW. “Usually, physicians worry about the blood sugar in diabetics, but it has been observed that even nondiabetics can develop postoperative hyperglycemia.”

This prospective study looked at 1,398 patients—with and without diabetes—who were treated with joint replacement surgery and were monitored and treated for hyperglycemia; these individuals were compared with 886 historic controls. The researchers found that using an enhanced glucose management program lowered the mean glucose and standard deviation from 129 ± 28 mg/dL to 123 ± 23 mg/dL for patients without diabetes. They also determined that the following contributed to elevated mean glucose in non-diabetics: preoperative fasting glucose, perioperative steroid use, general anesthesia, procedure duration, and transfusion.

Of the 968 nondiabetics, 203 developed severe hyperglycemia (129 of whom received insulin). The team found that no nondiabetic patients who were treated with insulin had mild or severe hypoglycemia.

“In our study, we identified that after orthopedic surgery, a group of nondiabetics do develop hyperglycemia,” stated Dr. Mannion to OTW. “Treatment of the hyperglycemia with insulin appears to lower the infection risk. Hyperglycemia in nondiabetics after major orthopedic [joint] replacement is equally as important as its occurrence in diabetics. The blood glucose should be monitored in all patients, especially during the first 1-2 days.”