Fully Closed Loop Glucose Control in Perioperative Period Delivers Superior Results versus Usual Care

Krutkyte G, Goerg AMC, Grob CA, et al. Perioperative Fully Closed-loop versus Usual Care Glucose Management in Adults Undergoing Major Abdominal Surgery - A Two-centre Randomised Controlled Trial. Ann Surg. 2024; in press.

Prevention of hyperglycemia through control of blood glucose levels during the perioperative period is associated with reduced mortality and morbidity rates for patients undergoing major abdominal surgical procedures.

According to evidence cited in the article, reductions in mortality and morbidity associated with adequate glucose control are observed in both diabetic and non-diabetic patients. Devices that continuously monitor blood glucose levels and administer insulin as needed (fully closed loop glucose control or FCL) can potentially provide safe and stable control of blood glucose levels during the immediate preoperative and postoperative intervals.

This randomized, prospective study compared the proportions of time that blood glucose levels were maintained in the desired target range (5.6–10.0 mmol/L) for patients (n = 37) managed using an FCL device or usual care (UC). UC was defined as periodic blood glucose testing with insulin dosage as needed.

UC was employed in 19 patients and FCL in 18 patients; included patients underwent hepatic, pancreatic, upper GI, and lower GI procedures. Glucose control within the target range was achieved in 80% of FCL patients and 54% of UC patients. No episodes of severe hypoglycemia or other adverse events were recorded in either group.

The authors concluded that the FCL approach provided superior perioperative glucose control compared to usual care.