Glycemic Management for High Blood Sugar in Surgical Patients

Enrolling by invitation at 1 trial location

Overseen By Shannon M Ruzycki, MD, MPH

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Calgary

Disqualifiers: Under 18 years

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to improve blood sugar management for patients undergoing surgery and staying in the hospital for more than 24 hours. It compares a new care plan, the Perioperative Glycemic Management Pathway, to usual care to determine which better reduces high blood sugar and related complications post-surgery. The focus is on improving recovery outcomes, such as shorter hospital stays and fewer readmissions. Patients diagnosed with diabetes, as well as those without a diagnosis but experiencing high blood sugar levels after surgery, might be suitable candidates. The goal is to ensure better health outcomes and reduce healthcare costs. As an unphased trial, this study allows patients to contribute to innovative care strategies that could enhance recovery and lower healthcare expenses.

Do I need to stop my current medications for the trial?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What prior data suggests that the Perioperative Glycemic Management Pathway is safe for surgical patients?

Research has shown that carefully controlling blood sugar levels during surgery can lead to better outcomes. High blood sugar in surgical patients increases the risk of complications and infections. Studies indicate that maintaining stable blood sugar can lower these risks and help patients recover more quickly.

The perioperative glycemic management pathway, a plan to control blood sugar around the time of surgery, has shown promise in improving these outcomes. Patients using this approach experienced fewer complications, shorter hospital stays, and a reduced need to return to the hospital. These findings suggest that this method is safe and effective for managing blood sugar during surgery. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it evaluates a new way to manage high blood sugar in surgical patients. Unlike the usual care, which follows standard practices for controlling blood sugar, this trial implements a perioperative glycemic management pathway that is based on national guidelines and supported by an implementation scientist team. This approach aims to provide more precise and evidence-based management of blood sugar levels, potentially improving patient outcomes during and after surgery. By comparing this pathway to the standard care, researchers hope to find out if this method offers superior control and benefits for surgical patients.

What evidence suggests that the Perioperative Glycemic Management Pathway is effective for managing high blood sugar in surgical patients?

Research has shown that controlling blood sugar levels around the time of surgery can lead to better patient outcomes. High blood sugar after surgery is linked to longer hospital stays and more infections. In this trial, participants in the intervention arm will follow the Perioperative Glycemic Management Pathway (PGMP) to reduce these risks by stabilizing blood sugar levels. Studies have demonstrated that patients using this method experienced better recovery results. This approach aims to lower complications and reduce healthcare costs. ^{1 2 5 6 7}

Are You a Good Fit for This Trial?

This trial is for adults over 18 who are undergoing surgery and will be in the hospital for more than a day afterward. It's designed to help those at risk of high blood sugar after their operation, including people with known or undiagnosed diabetes.

Inclusion Criteria

I am an adult who will be in the hospital for more than a day after surgery.

Exclusion Criteria

I am under 18 years old.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Implementation

Implementation of the Perioperative Glycemic Management Pathway (PGMP) in surgical patients to manage postoperative glycemia and improve outcomes

3 months

Regular monitoring visits as per hospital protocol

Follow-up

Participants are monitored for safety and effectiveness after implementation of PGMP, including length-of-stay, readmission rates, and surgical site infections

12 months

What Are the Treatments Tested in This Trial?

Interventions

• Perioperative glycemic management pathway

Trial Overview The trial tests a Perioperative Glycemic Management Pathway (PGMP) against usual care to see if it can better manage post-surgery blood sugar levels, shorten hospital stays, reduce readmissions, and save costs. The study involves multiple hospitals and uses a stepped-wedge design.

How Is the Trial Designed?

Group I: Intervention: PGMP Active Control 1 Intervention

Sites will implement a perioperative glycemic management pathway based on national guidelines and current evidence, with support of an implementation scientist team.

Group II: Non-intervention: usual care Active Control 1 Intervention

Sites will perform usual perioperative glycemic management.

Who Is Running the Clinical Trial?

University of Calgary

Lead Sponsor

Trials

827

Recruited

902,000+

Citations

1. ncbi.nlm.nih.gov ncbi.nlm.nih.gov/books/NBK540965/

Diabetic Perioperative Management - StatPearls - NCBI - NIH The American Diabetes Association (ADA) recommends a target blood glucose range of 80 to 180 mg/dL in the perioperative period and 140 to 180 mg ...

2. sciencedirect.com sciencedirect.com/science/article/pii/S2667242125000582

The impact of perioperative hyperglycemia on ... In summary, both acute and chronic perioperative hyperglycemia significantly contribute to the risk and severity of cognitive impairments, including POCD. The ...

3. bjaed.org bjaed.org/article/S2058-5349(24)00049-0/fulltext

Update on the perioperative management of diabetes ... A subgroup analysis of the cohort of 1065 patients with diabetes mellitus reveals a similar result (11.2% vs 13.6%, 95% CI=−6.6 to 1.6).

4. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC3641560/

Hyperglycemia and Perioperative Glucose Management For example, in cardiac surgical patients, severe hyperglycemia occurring during surgery was a strong predictor of mortality and multi-system morbidity [7].

5. albertahealthservices.ca albertahealthservices.ca/scns/Page13972.aspx

Perioperative Glycemic Management High blood sugar a¬fter surgery is associated with worse patient outcomes – including longer hospital stay, more surgical site infections, and even higher ...

6. diabetesjournals.org diabetesjournals.org/diabetes/article/74/Supplement_1/1077-P/159414/1077-P-Improving-Glycemic-Control-in-Surgical

1077-P: Improving Glycemic Control in Surgical Patients ... Conclusion: Implementation of a “fast track” pre-operative referral pathway to endocrinology demonstrated significant improvement in glycemic ...

7. sciencedirect.com sciencedirect.com/science/article/abs/pii/S1357303924002512

Perioperative management of diabetes mellitus and ... They have an increased risk of postoperative complications (infective and non-infective), prolonged lengths of stay, increased readmission and higher mortality ...