Rationale:

• Because patients will likely have altered their meal times and be fasting before surgery, they should monitor their glucose levels at home to ensure they are not low and be vigilant for early symptoms of hypoglycemia before and after surgery.
• Early identification of hypoglycemia allows for prompt treatment to halt progression.
• Because diabetic patients are at increased risk of having coronary artery disease, they need to be able to identify symptoms of cardiac ischemia and to seek medical attention immediately.
• Determining details of outpatient therapy helps guide intraoperative diabetes management and allow for accurate resumption of the patient's medication therapy in the postoperative phase.
• Early morning surgery, especially for procedures where the patient is expected to resume oral intake on the same day, minimizes disruption in glucose reduction therapy and therefore glycemic control.

Evidence:

• In a case-control study of patients with deep sternal site infections after coronary artery bypass grafting, those with diabetes with a preoperative glucose level >110 mg/dL had a higher risk of deep sternal wound infections (OR, 1.4 [CI, 0.4 to 4.8]; P=0.6) (8).
• A prospective cohort study of outpatients showed that low self-monitored blood glucose levels predicted severe episodes of hypoglycemia (stupor or unconsciousness) among patients with type 1 diabetes (19).
• The American Diabetes Association published recommendations for glycemic goals for outpatients (35).

Comments:

• None.