Pharmacists Improve Post-Surgical Outcomes for Diabetics

Patients with diabetes fare better after surgery when pharmacists manage their high blood sugar.

In a recent study, diabetics in a pharmacist-led glycemic control program who underwent surgery saw fewer complications and readmissions than those who had surgery before the program started.

“In our system, pharmacists have the most knowledge about medications to manage blood sugar, and often patients need their insulin doses adjusted several times in the days after surgery,” study authors Karen Mularski, MD, and David Mosen, PhD, MPH, told Pharmacy Times. “In many health systems, other providers are managing blood sugar, in addition to their regular duties.”

The pharmacists involved in the study were tasked with managing blood sugar in non-critically ill postoperative surgical patients with diabetes. The researchers compared the results with a 1-year pre-intervention period to determine how patient outcomes differed.

The Kaiser Permanente researchers measured patients’ glycemic control, hypoglycemia, post-discharge health care utilization, and 6-month per patient per month medical costs. They sought to determine whether the pharmacist-led team could reduce complications, readmissions, and after-discharge costs.

The pharmacists worked alongside surgeons, hospitalists, endocrinologists, diabetes educators, and nutritionists to develop protocols for when to begin and end intravenous (IV) insulin, how to transition from IV to subcutaneous insulin, how to adjust insulin doses, and how to manage patients on tube feedings or IV nutrition.

The study population totaled 11,553 patients, of whom 1277 were in the pre-intervention phase, 4811 were in the first year of the intervention, and 5465 were in the second year of the invention.

Patients in the second year of the intervention displayed the following evidence of superior outcomes over the nonintervention group:

• The intervention group was more than 2 times as likely to have well-controlled blood sugar 1 day post-surgery.
• The intervention patients were 69% less likely to have hypoglycemia in the 3 days following surgery.
• The pharmacist-controlled cohort was one-third less likely to be readmitted to the hospital in the course of 3 months after discharge.
• The intervention patients were almost one-third less likely to visit the emergency department in the 3 months following discharge.

Drs. Mularski and Mosen told Pharmacy Times that they expecte to see improvement in blood sugar control, but they were pleasantly surprised by the other findings.

“The main takeaway is that by resourcing a glycemic control pharmacist program, we can not only improve blood sugar control and reduce hypoglycemia—key safety measures in themselves—but also apparently prevent later complications that could lead to return visits to the emergency department or readmission to the hospital,” they said.

The researchers calculated that the intervention patients saved approximately $284 per month in medical costs after discharge compared with the control group.

“Surgeons and anesthesia providers may not have the time or expertise to appropriately monitor and adjust insulin regimens after surgery,” Drs. Mularski and Mosen told Pharmacy Times. “…[W]hat’s important is that someone who is well trained is dedicated to managing patients’ blood sugar, and that we do it proactively rather than reactively waiting for them to have a high blood sugar reading and then trying to rectify it.”

These study findings were published in the American Journal of Pharmacy Benefits.