Glycaemic control during surgery in diabetic patients at Kenyatta National Hospital
Objective - To study the patterns of glycaemic control in diabetic patients undergoing surgery in Kenyatta National Hospital. Design - A cross sectional, prospective study. Setting - Kenyatta National Hospital operating rooms Subjects - Diabetic patients undergoing emergency or elective surgery Methods - Over five months, November 2005 to March 2006. Glycated haemoglobin was determined as well as blood sugar levels pre-operatively, at half hourly or hourly intervals intra-operatively and at reversal from anaesthesia. The vital signs of the patients at reversal were noted. Results - The mean HbA 1c was 4.17%, and the mean pre-operative blood sugar was 8.7 mmolll, and the mean intra-operative blood sugar was 9.14 mmolli. There was no statistically significant correlation between HbAlc and age, sex and duration of diabetes, but there was statistically significant correlation between HbA 1c and random blood sugar taken at interval intra-operatively. Most of the patients managed on diet, did not receive insulin intra-operatively. The mean total amount of insulin used intra-operatively was 6.7 units. 6.2% of patients reversed poorly from anaesthesia and their mean blood sugar was 10.1 mmolli. 14.8% of patients who reversed poorly had HbAlc > 6.4%. 4.4 % of patients were admitted into the intensive care unit due to respiratory distress and septic shock. Conclusion - Pre-operative glycaemic control was optimal and patients managed on diet had the best control and did not require insulin during surgery. Glycaemic control (mean blood sugar < 10 mmolll) was achieved intra-operatively through use of insulin and this was not associated with immediate post-operative complications.