Anesthesiological perspectives on perioperative management in continuous subcutaneous insulin infusion (CSII): stop or continue?

Objective Perioperative handling of insulin pumps (CSII) is inconsistent. The aims of this study were a literature search addressing this clinical question, analysis of data found and a proposal for perioperative management recommendations for clinical practice. Methods A systematic search was conducted in PubMed and Clinical Research Network. Results and discussion A total of 11 publications on CSII in perioperative medicine were identified. According to the evidence CSII guarantees perioperative glycemic stability under certain clinical situations. The use of CSII could be continued in patients undergoing elective non-cardiac minor surgery with fasting for up to one meal only. International guidelines on surgery in diabetes do not address the use of perioperative CSII. There is no nationwide register data for CSII, the use of which could be around 18%. Based on the search results, a hospital internal protocol for perioperative management with CSII and patient information material were designed. Conclusion Growing evidence for improved patient outcome with perioperative CSII usage warrants interdisciplinary transfer of knowledge and experiences on intensified insulin therapy and patient empowerment.