الفهرس 
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Abstract
Hip arthroplasty are one of the most common orthopedic procedures. Strict perioperative glycemic control is important for patients with and without DM. Sliding scale insulin (SsI) is regularly prescribed as part of the medical treatment in hospitalized diabetic people, despite the lack of physiological congruence and strong evidence to support it. Hyperinsulinemia-normoglycemia is a well-established glycemic management technique that is based on preoperative carbohydrate loading combined with insulin therapy to maintain normoglycemic status or what is called “glucose insulin (GIN) therapy”. Thus, the aim of this study was to compare between the continuous insulin infusion method versus sliding scale method in glycemic control and decreasing the rate of postoperative wound infection in diabetic patients undergoing elective hip arthroplasty. This study was prospective randomized controlled trial that was conducted at the Orthopedic Department, Tanta University Hospitals during the period of study that extended from January 2023 till June 2023 and included 40 Patients with type II diabetes aged from 35 to 70 years old and underwent elective hip arthroplasty having ASA II or III. Those patients were randomly allocated into two groups nominated: group C or Control group to whom Insulin was given as intravenous bolus (sliding scale group) and group P or Protocol group where regular insulin was administered in a concentration of 100U insulin on 100mL of normal saline by Infusion and if there was no response to initial dose of insulin or still measurements were higher than preset range, doses were doubled. Regarding the demographic data of the study participants, our results revealed that there was non-statistically significant difference between both studied groups regarding age, Gender & BMI (kg/m2) (P > 0.05). Most included cases were elderly people with the mean age of cases was 63.50 ± 4.741 years in groups P and 60.90 ± 4.656 years in group C (P =0.088), also most included cases were males 60.0% in groups P and 55% in group C (P = 0.749). The mean body mass index was high and nearly the same in both studied groups (31.40 ± 1.831 kg/m2 in groups P and 31.32 ± 1.842 kg/m2 in group C) (P = 0.897). Regarding the baseline preoperative laboratory investigations of the study participants, our results revealed that there was non-statistically significant difference between both studied groups regarding serum hemoglobin (gm/dl), WBCs Platelets, prothrombin time (seconds), liver and renal function tests parameters (P > 0.05). The mean Hemoglobin A1C of cases was matched in between study groups as it was 7.24 ± 0.419 in groups P and 7.32 ± 0.446 in group C (P =0.587). Patients were selected for elective operation and the routine tests were suitable for operations As regards, the duration of surgery of the studied groups: the mean duration of surgery was lower in group C (2.88 ± 0.64) hours than in group P (3.25 ± 0.698 hour) but the difference was not statistically significant (P =0.086). As regard intraoperative vitals of the studied groups, our results revealed that there was non-statistically significant difference between both studied groups regarding subsequent heart rate measurements prior surgery start(baseline), and at 15, 30,45.60,90,120,150,180,210 and 240 minutes. All measurements were slightly higher in group C but the difference was not statistically significant (P > 0.05 for all readings). Furthermore, our results revealed that there was non-statistically significant difference between both studied groups regarding subsequent MAP measurements prior surgery start (baseline), and at 15, 30,45,60,90,120,150,180,210 and 240 minutes (P > 0.05 for all readings). So, Spinal anesthesia provided hemodynamic stability, no episodes of severe hypotension or bradycardia. As regard intraoperative random blood sugar follow-up of the studied groups, our results revealed that prior surgery start (at baseline) there was non-statistically significant difference between both studied groups regarding random blood sugar (P > 0.05). However, there was statistically significant decrease in the random blood sugar measurements in group P who were subjected to insulin infusion than group C who subjected to sliding insulin scale at 1, 2, 3 and 4 hours follow up during surgery (P 0.001 for all measurements). As regard postoperative random blood sugar follow-up of the studied groups, our results revealed that there was still statistically significant decrease in the random blood sugar measurements in group P who were subjected to insulin infusion than group C who subjected to sliding insulin scale at the 1st, 2nd, 3rd, 4th, 5th, 6th, 7th and 8th hours follow up after surgery (P 0.001 for the first 6 hours, P= 0.004 for the 7th hour, and P= 0.041 for the 8th hour measurements). However, there was non-statistically significant difference between both studied groups regarding random blood sugar measurements after the 8th hour passage (from the 9th till the end of 24th hour following the surgery). As regard postoperative outcomes, infection was absent in the 5 days postoperative (0% in both groups) serum procalcitonin levels during 5 days follow-up of the studied groups, our results revealed that there was statistically significant decrease in the serum procalcitonin levels in group P who were subjected to insulin infusion than group C who subjected to sliding insulin scale at the 2nd and 3rd, days post-operative (P= 0.0035 for the 2nd day, and P= 0.043 for the 3rd day). However, there was non-statistically significant difference between both studied groups regarding serum procalcitonin levels at the baseline, 1st, 4th and 5th days post-operative (P > 0.05). In contrary, there was non-statistically significant difference between both studied groups regarding TLC, CRP or ESR at the baseline, 1st, 2nd, 3rd , 4th and 5th days post-operative (P > 0.05 for all). Regarding postoperative hospital stay: the mean duration of hospital stay was lower in group C (4.55 ± 1.395) days than in group P (5.15 ± 1.461 days) but the difference was not statistically significant (P =0.192). In conclusion insulin infusion is better in perioperative blood glucose control but further large-scale studies would be needed to promote insulin infusion as a potential treatment in glycemic control in orthopedic surgery.