Should continuous subcutaneous insulin infusion (CSII) pumps be used during the perioperative period? Development of a clinical decision algorithm

According to the Centers for Disease Control and Prevention, there are 30.3 million Americans with diabetes mellitus (DM). It is estimated that more than 400,000 individuals with DM are using continuous subcutaneous insulin infusion (CSII) pumps as a method to maintain blood glucose control. An alternative to intermittent daily insulin injections, CSII more closely mimics normal physiologic insulin delivery. Maintaining glycemic control in the surgical patient using CSII requires a well-designed plan to minimize potential risks associated with this method of insulin delivery. A search strategy was formulated to examine the literature on CSII pumps use during the perioperative period as a method of maintaining glycemic control in surgical patients with DM. Seven potential sources were identified, which included a single case study and 3 retrospective cohort studies. Although methodologic concerns with the studies were found, the evidence suggests that CSII pumps can be safely utilized during the perioperative period when an established protocol is used. A multidisciplinary team at a large military medical center was formed to develop a decision-making algorithm to assist anesthesia providers in caring for patients with CSII pumps.