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INFECTION PREVENTION
Ron Olson, MD
Reducing SSIs in Diabetics
Glucose control is just one part of a much bigger picture.
W
e know
surgical
site
infections are
common in diabetic patients, and
even more common in patients
(known diabetics
and others) with
higher pre-operative glucose and
BALANCING ACT Using insulin to lower glucose levels can
decrease some risks while simultaneously increasing others.
hemoglobin A1C
levels. Insulin normalizes glucose and also has anti-inflammatory benefits that are known to reduce SSIs in diabetics and non-diabetics. So
you'd probably assume that using pre-operative insulin infusions to
reduce glucose levels would reduce the risk of SSIs and overall morbidity.
Not necessarily.
While it's true that high glucose produces an environment that
interferes with healing and predisposes patients to infections, it's
likely that many of the SSIs suffered by diabetics come from secondary conditions, such as neuropathy and microcirculatory deficits.
And those are conditions that can't be changed quickly. In addition,
stress increases glucose levels, so high glucose may be as much a
marker of increased perioperative risk as a cause of it. Complicating
matters further is the fact that while high glucose is bad, so is low
glucose. You may reduce some risks by lowering glucose levels, but
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O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | S E P T E M B E R 2013
