This review addresses the increasing use of wearable diabetes devices, including continuous glucose monitors (CGMs) and insulin pumps, in patients undergoing surgery. It highlights the need for clear perioperative management strategies as these technologies, particularly automated insulin delivery (AID) systems, become more common.
Key Recommendations
- Monitoring and Management: CGMs should complement, but not replace, point-of-care glucose monitoring during surgery. Interference from factors like electrocautery and fluoroscopy can lead to inaccurate glucose measurements.
- Device Continuation vs. Removal: Whenever feasible, CGMs and insulin pumps should be left in place to avoid treatment interruptions. AID systems, which rely on continuous glucose data, should not be disrupted unless absolutely necessary. If removal is necessary, alternative insulin delivery strategies must be pre-planned.
- Preoperative Planning: Assess the procedure’s duration, invasiveness, and compatibility with device placement to determine if wearable devices can remain in use. Patients should be informed about risks, and teams should develop contingency plans for glucose management.
- Intraoperative Use: Insulin pumps and AID systems may be used during shorter, less invasive procedures with frequent glucose checks and monitoring for device malfunctions. Patients undergoing longer or complex procedures may require temporary transition to subcutaneous or intravenous insulin delivery.
- Postoperative Considerations: Patients should resume CGM and insulin pump use postoperatively, with continued glucose monitoring to validate accuracy. Policies governing inpatient use of these devices should align with institutional protocols.
Additional Considerations
- Ensure compatibility with intraoperative imaging (e.g., avoid MRI exposure) and minimize mechanical pressure on devices that could distort readings.
- AID systems should be carefully monitored, as interruptions can lead to hyperglycemia or diabetic ketoacidosis if basal insulin delivery fails.
Conclusion
This review highlights the rapid adoption of wearable diabetes devices and the need for standardized perioperative guidelines. Future research should focus on evaluating the safety and efficacy of intraprocedural AID system use to optimize patient care.
