Perioperative Management of Patients with Diabetes

Abstract

Hyperglycemia has long been recognized to have detrimental effects on postoperative outcomes in patients undergoing surgery. The manifestations of uncontrolled diabetes are manifold and can include risk of hyperglycemic crises, postoperative infection, poor wound healing, and increased mortality. There is substantial literature supporting the role of diligent glucose control in the prevention of adverse surgical outcomes, but considerable debate remains as to the optimal glucose targets. Hence, most organizations advocate the avoidance of hypoglycemia while striving for adequate glucose control in the perioperative period. These objectives can be accomplished with careful preoperative evaluation, clear patient instructions the day of surgery, frequent blood glucose monitoring during the perioperative period, and use of effective strategies for insulin initiation and titration. This article highlights the major issues concerning patients with diabetes undergoing surgery and reviews the management recommendations put forth by general consensus guidelines and expert opinion.

RSSDI-ESI clinical practice recommendations for the management of type 2 diabetes mellitus 2020

“…[ 799 ] Physicians and multidisciplinary care teams must comprehend strategic plan to optimize glycaemia management in diabetic patients undergoing surgery. [ 806 ]…”

“…Measurement of serum creatinine level to assess DKD, haemoglobin HbA1c, and blood glucose level are the critical baseline laboratory data that must be assessed. [ 806 ] Other critical assessments that must be considered are enumerated below [ Table 24 ].…”

“…[ 809 810 811 ] DPP-4 inhibitors may be discontinued before surgery; however, in a recent study establishing the safety and efficacy of sitagliptin alone or sitagliptin in combination with basal insulin in hospitalized medical and surgical patients demonstrated good tolerability and low risk of hypoglycaemia and can be considered as a viable option in the perioperative setting. [ 806 812 ] Due to slow gastric motility GLP-1 agonists (exenatide, liraglutide) are usually withheld the day before surgery. [ 809 813 ] However, in cardiac and noncardiac surgical patients addition of a GLP-1 agonists to insulin therapy has demonstrated improved perioperative glycaemic control.…”

“…[ 802 ] To maintain the glucose targets intraoperatively, IV insulin infusion regimen-a protocol-driven algorithm is recommended. [ 806 ]…”

Analysis of the course of treatment of patients with corticosis using endoprosthesis in the context of the need to personalize the rehabilitation process

“…The percentage of patients with diabetes and concomitant functional disability is growing rapidly and is now becoming an increasingly serious health problem. Patients suffering from diabetes who require surgical intervention are a challenge for health care, because its presence is associated with numerous perioperative complications in the form of infections, delayed wound healing, metabolic complications and increased mortality [20]. Epidemiological estimates indicate that the incidence of diabetes will increase by about 69% in developing countries and 20% in developed countries in 2010-2030 [21].…”