McHenry County General and Vascular Surgeon Dr. Basudeb Saha Discusses the Importance of Glucose Control in the Surgical Patient
MCHENRY, IL--(Marketwired - Aug 19, 2014) - Diabetes mellitus is an extremely common medical condition, affecting 8% of the U.S. population. The prevalence of diabetes is even higher in hospitalized patients, with an estimated 15-25% of hospitalized patients having diabetes. Complications from diabetes are common and directly increase the need for surgery. In fact, it is estimated that 25% of diabetics will require surgery. Diabetic patients are at a much higher risk of developing surgical complications, often due to infections resulting from poor postoperative glucose control. "It is extremely important that you discuss your diabetes with your surgeon prior to surgery," states Dr. Basudeb Saha. If your health care team is aware of your condition, a plan can be made to control your glucose levels perioperatively.
Optimizing glucose control perioperatively is more important than ever. "We know so much more these days than we used to about the importance of controlling sugars around the time of surgery," states Dr. Saha. "There have been many studies done recently that indicate higher glucose levels are associated with poor clinical outcomes in surgical patients," states Dr. Basudeb Saha. These studies indicate that surgical patients with higher sugars have increased death rates. And this observation is not only seen in surgical patients, but also in several groups of medical patients, including those who have suffered strokes and heart attacks. Patients with poor sugars are also at increased risk of infections and have poorer wound healing.
"What we don't know is the degree to which we should control blood sugars," states Dr. Saha. "We have to be careful because studies have shown that intensive control, which is normally recommended for diabetic patients at home to prevent long term complications, is not ideal in the hospital setting." The multicenter Normoglycemia in Intensive Care Evaluation Survival Using Glucose Algorithm Regulation (NICE-SUGAR) trial evaluated intensive glucose control in both medical and surgical intensive care units. Patients' blood sugars were kept under either intensive control (target level of 81-108 mg/dL) or conventional control (target level of < 180). Patients in the intensive glucose control group had an increased 90 day mortality rate as well as a significantly higher rate of severe low sugars (< 40 mg/dL) which can lead to coma and death. "For this reason, we aim to keep sugars somewhere in between; in the 140-180 mg/dL range," states Dr. Saha.
This is sometimes easier said than done, especially in the surgical patient. Following surgery there are many factors that affect glucose control; two of which are postoperative pain, and diet restrictions. Patients may find they require much more or less diabetes medication than they did prior to surgery. Given the importance of good blood sugars on surgical outcomes, Dr. Saha advises that patients do their best to get their blood sugars under control prior to surgery. If you are diabetic and planning on undergoing a surgery, talk to your surgeon about the plans for postoperative glucose management. The more prepared you are, the more likely you are to have a successful surgery and recovery.
About Basudeb Saha, MD, FACS
Dr. Saha earned his medical degree at the prestigious All India Institute of Medical Sciences in New Delhi, India. He later completed his training in general surgery at the New Jersey College of Medicine where he also served as Chief Resident. He completed a fellowship in Cardiovascular and Thoracic Surgery at Georgetown University in Washington D.C. Dr. Saha is board-certified by the American Board of General Surgery and is a Fellow of the American College of Surgery. He has received numerous excellence awards in his general practice and maintains active memberships in the American College of Surgery and several other prestigious organizations. He is available for interview upon request.
