Insulin Advancements Led to Safer Surgeries, Shorter Hospital Stays

Thanks to the introduction of novel insulins and advanced technology, the perioperative management of diabetes has improved drastically, according to a study published in the British Journal of Anaesthesia.¹ Despite the recent advancement of insulins for managing diabetes, researchers expect more developments in the future that will cause diabetes recommendations to evolve.

“Although the prevalence of diabetes is ∼10% in the community, it is ∼25% in the inpatient and surgical patients, and it may be as high as 35% in the critical care patients, particularly in the cardiac or cardiac surgical patients,” wrote the authors. “Diabetes is also associated with cognitive and functional disability, metabolic dysfunction-associated fatty/steatotic liver disease (MASLD/MAFLD), obstructive sleep apnea, and depression. Therefore, optimizing glycemic control from the time of diagnosis is paramount to prevent or delay the onset of these multiple chronic complications.”

From 2010 to 2019, there were a total of 78 million diabetes-related hospitalizations, according to a study published in the Journal of Clinical Medicine.² During this time period, rates increased from 3079 to 3280.8 per 100,000 patients. Study researchers owed the rising diabetes hospitalizations to a simultaneous increase in diabetes cases during the same time period. According to CDC statistics, 38.4 million people in the US had diabetes.³

Researchers assessed which insulin regimens would be the most effective for patients with diabetes undergoing surgery. | image credit: miss irine / stock.adobe.com

READ MORE: Q&A: Current Advancements in Insulin Delivery for Patients with Diabetes

Regardless of the overall diabetes prevalence, the association between diabetes and hospitalizations is alarming because of this population’s increased risk of poor health outcomes. With the use of emerging technologies in the diabetes space, providers and patients alike now have a myriad of options for controlling glycemia while avoiding chronic complications.

Researchers wanted to better understand those options, demonstrating their safety and efficacy in the perioperative setting.

“To mitigate the complications of diabetes, several therapeutic options are available that can be broadly characterized into pharmacological and non-pharmacological,” they wrote.¹ “This narrative review discusses the insulins that are available for the management of diabetes, and the pharmacological options that are available for managing diabetes with insulins in the perioperative period and within critical care. Furthermore, the risks associated with each option are discussed.”

Providing an in-depth background on insulin therapies and their mechanisms, researchers added context to the significant advancements in diabetes technology. From the first successful insulin treatment in 1921 to today, there are currently 5 types of insulin available for patients with diabetes: rapid-acting insulin analogues, regular soluble human insulin, intermediate-acting insulin, long-acting insulin analogues, and ultralong-acting insulin analogues.

As other areas of technology have improved, such as artificial intelligence and continuous glucose monitors becoming a standard of practice, diabetes management has become much more reasonable for patients within their communities. However, similar advancements may not be realized in perioperative settings, where surgery on people with diabetes holds a mortality risk ranging from 3.7% to 13.2%.¹

While dealing with patients in a differing location and state of being, there too are a slew of insulin regimens being used during surgeries. According to study authors, insulin methods being explored perioperatively include the glucose–insulin–potassium regimen, variable rate intravenous insulin infusion (VRIII), basal-only insulin, basal-bolus insulin, and many more. For patients that are in intensive care or are experiencing stress hyperglycemia, VRIII is the recommended insulin regimen.

“The management of diabetes during the perioperative period should begin as soon as the decision to proceed with a surgical procedure is made,” continued the authors.¹ “Pharmacy teams have an integral role in ensuring safe administration of medicines during the perioperative period. Increasingly, they are an integral part of preassessment clinics to ensure reconciliation of medicines before admission to reduce medication errors.”

When it comes to controlling diabetes outcomes during an operation, providers need to be much more aware of their patients’ characteristics and disease state compared with everyday, community-dwelling patients. Prior to operation, it’s imperative that pharmacists understand the proper insulin regimens to proceed with what will best accommodate patients. For patients with diabetes experiencing a surgery, they require a significantly personalized approach.

In more than the past 100 years, diabetes technology has improved substantially and patients are finding new ways to improve their outcomes on a daily basis. However, diabetes burdens continue to rise and hospitalizations continue to occur. Despite these significant advancements, more will inevitably be developed to potentially improve the management of diabetes.

“This review has discussed the current state of the safe use of insulin medicines during surgery and critical care admission; however, it is expected that further medications and drug delivery systems will be developed, and thus strategies will continue to evolve,” concluded the authors.¹ “Future researchers and perioperative teams will need to elucidate the precise required perioperative modifications for the new technology and medicines; however, the underlying principles of maintaining the glucose concentration in a safe range, preventing hypoglycemic or hyperglycemic crisis, and preventing adverse drug events will remain.”

READ MORE: Insulin Management Resource Center

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References

1. Dhatariya K, Levy NA, Stubbs D, et al. Development of insulin(s) and its pharmacology and perioperative use: a narrative review. Br J Anaesth. Published online June 6, 2025. https://doi.org/10.1016/j.bja.2025.05.006

2. Rubens M, Ramamoorthy V, Saxena A, et al. Recent trends in diabetes-associated hospitalizations in the United States. J Clin Med. 2022 Nov 9;11(22):6636. doi: 10.3390/jcm11226636.

3. National diabetes statistics report. CDC. May 15, 2024. Accessed July 11, 2025. https://www.cdc.gov/diabetes/php/data-research/index.html