Efficacy of Perioperative Basal-Bolus Insulin Therapy on Blood Glucose Variability in Non-Insulin-Dependent Type 2 Diabetes Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Trial.

Abstract

Total knee arthroplasty (TKA) is a common orthopaedic procedure, but perioperative glycemic control remains challenging for patients who have diabetes. While preoperative optimization is ideal, it is not always feasible. Blood glucose variability has emerged as an important indicator of glycemic control, with fluctuations potentially more harmful than sustained hyperglycemia. This study aimed to evaluate the efficacy of different insulin regimens on perioperative blood glucose variability in non-insulin-dependent type 2 diabetes patients undergoing TKA. We conducted a randomized controlled trial with 120 non-insulin-dependent type 2 diabetes patients scheduled for TKA between November 2023 and October 2024. Patients were randomized to receive basal-bolus insulin (BBI) therapy, receive sliding scale insulin (SSI) therapy, or continue oral hypoglycemic drugs preoperatively. Postoperative blood glucose variability, insulin resistance, β-cell activity, wound complications, and other clinical outcomes were compared between groups. The BBI group demonstrated notablely lower postoperative blood glucose variability compared to the SSI and oral hypoglycemic groups (15.6 ± 2.9% versus 20.7 ± 5.0% versus 24.6 ± 7.0%, respectively). In addition, the BBI group showed lower levels of insulin resistance and β-cell activity. However, no significant differences were observed in postoperative inflammatory markers among the three groups. This study provides evidence that perioperative BBI therapy can effectively reduce blood glucose variability and insulin resistance in non-insulin-dependent type 2 diabetes patients undergoing TKA. These findings contribute to optimizing perioperative glycemic management strategies for this patient population.