{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T21:01:14Z","timestamp":1794344474730,"version":"4.9.0"},"reference-count":45,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:p>The increasing prevalence of diabetes mellitus has been accompanied by a rapid expansion in wearable continuous glucose monitoring (CGM) devices and insulin pumps. Systems combining these components in a \u201cclosed loop,\u201d where interstitial glucose measurement guides automated insulin delivery (AID, or closed loop) based on sophisticated algorithms, are increasingly common. While these devices\u2019 efficacy in achieving near-normoglycemia is contributing to increasing usage among patients with diabetes, the management of these patients in operative and procedural environments remains understudied with limited published guidance available, particularly regarding AID systems. With their growing prevalence, practical management advice is needed for their utilization, or for the rational temporary substitution of alternative diabetes monitoring and treatments, during surgical care. CGM devices monitor interstitial glucose in real time; however, there are potential limitations to use and accuracy in the perioperative period, and, at the present time, their use should not replace regular point-of-care glucose monitoring. Avoiding perioperative removal of CGMs when possible is important, as removal of these prescribed devices can result in prolonged interruptions in CGM-informed treatments during and after procedures, particularly AID system use. Standalone insulin pumps provide continuous subcutaneous insulin delivery without automated adjustments for glucose concentrations and can be continued during some procedures. The safe intraoperative use of AID devices in their hybrid closed-loop mode (AID mode) requires the CGM component of the system to continue to communicate valid blood glucose data, and thus introduces the additional need to ensure this portion of the system is functioning appropriately to enable intraprocedural use. AID devices revert to non-AID insulin therapy modes when paired CGMs are disconnected or when the closed-loop mode is intentionally disabled. For patients using insulin pumps, we describe procedural factors that may compromise CGM, insulin pump, and AID use, necessitating a proactive transition to an alternative insulin regimen. Procedure duration and invasiveness is an important factor as longer procedures increase the risk of stress hyperglycemia, tissue malperfusion, and device malfunction. Whether insulin pumps should be continued through procedures, or substituted by alternative insulin delivery methods, is a complex decision that requires all parties to understand potential risks and contingency plans relating to patient and procedural factors. Currently available CGMs and insulin pumps are reviewed, and practical recommendations for safe glycemic management during the phases of perioperative care are provided.<\/jats:p>","DOI":"10.1213\/ane.0000000000007115","type":"journal-article","created":{"date-parts":[[2024,6,24]],"date-time":"2024-06-24T13:56:13Z","timestamp":1719237373000},"page":"2-12","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":31,"title":["Perioperative Care of Patients Using Wearable Diabetes Devices"],"prefix":"10.1213","volume":"140","author":[{"given":"Paulina","family":"Cruz","sequence":"first","affiliation":[{"name":"Division of Endocrinology, Metabolism & Lipid Research, Department of Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexis M.","family":"McKee","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Metabolism & Lipid Research, Department of Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hou-Hsien","family":"Chiang","sequence":"additional","affiliation":[{"name":"Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington School of Medicine, University of Washington, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet B.","family":"McGill","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Metabolism & Lipid Research, Department of Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irl B.","family":"Hirsch","sequence":"additional","affiliation":[{"name":"Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington School of Medicine, University of Washington, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle","family":"Ringenberg","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Troy S.","family":"Wildes","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,1,24]]},"reference":[{"key":"R1-20250224","first-page":"284063","article-title":"Guidelines for perioperative management of the diabetic patient.","volume":"2015","author":"Sudhakaran","year":"2015","journal-title":"Surg Res Pract"},{"key":"R2-20250224","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1097\/ALN.0000000000001515","article-title":"Perioperative hyperglycemia management: an update.","volume":"126","author":"Duggan","year":"2017","journal-title":"Anesthesiology"},{"key":"R3-20250224","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1001\/jama.2022.24075","article-title":"Surgical site infection prevention: a review.","volume":"329","author":"Seidelman","year":"2023","journal-title":"JAMA"},{"key":"R4-20250224","doi-asserted-by":"crossref","first-page":"1655","DOI":"10.1016\/j.mayocp.2020.10.002","article-title":"Preoperative management of endocrine, hormonal, and urologic medications: Society for Perioperative Assessment and Quality Improvement (SPAQI) consensus statement.","volume":"96","author":"Pfeifer","year":"2021","journal-title":"Mayo Clin Proc"},{"key":"R5-20250224","article-title":"Society for Ambulatory Anesthesia Updated Consensus Statement on Perioperative Blood Glucose Management in adult patients with diabetes mellitus undergoing ambulatory surgery.","author":"Rajan","journal-title":"Anesth Analg"},{"key":"R6-20250224","article-title":"Guideline for perioperative care for people with diabetes mellitus undergoing elective and emergency surgery."},{"key":"R7-20250224","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1056\/NEJM199309303291401","article-title":"The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus.","volume":"329","author":"Nathan","year":"1993","journal-title":"N Engl J Med"},{"key":"R8-20250224","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1016\/S0140-6736(98)07019-6","article-title":"Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). 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