Abstract
The patients with diabetes are treated with a variety of regimens and are scheduled for surgery at varying times of the day, there is no established consensus for optimal preoperative management. Perioperative glycemic control has a significant impact on the risk of infectious complications - including pneumonia, wound infection, urinary tract infection and sepsis - in patients with diabetes undergoing a variety of surgical procedures. Therefore, the goal of preoperative glycemic control is to avoid hypoglycemia, excessive hyperglycemia, lipolysis, protein catabolism, electrolyte disturbance and ketoacidosis. However, the effects of preoperative glycemic control are not definitive. Patients with type 1 diabetes should receive insulin replacement, while those with type 2 diabetes may need to discontinue oral medications prior to surgery and might require insulin therapy to maintain blood glucose control. The actual treatment should be individualized for each patient, based on diabetes classification, usual diabetes regimen, state of glycemic control, and extent of the surgical procedure. Medical judgment should override these recommendations as needed. Whenever possible, metabolic abnormalities should be corrected, and surgery should be scheduled early in the day.
REFERENCES
1. Dronge AS, Perkal MF, Kancir S, Concato J, Aslan M, Rosenthal RA. Longterm glycemic control and postoperative infectious complications. Arch Surg. 2006; 141:375–80.
2. King JT Jr, Goulet JL, Perkal MF, Rosenthal RA. Glycemic control and infections in patients with diabetes undergoing noncardiac surgery. Ann Surg. 2011; 253:158–65.
3. Trick WE, Scheckler WE, Tokars JI, Jones KC, Reppen ML, Smith EM, Jarvis WR. Modifiable risk factors associated with deep sternal site infection after coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2000; 119:108–14.
4. Galloway JA, Shuman CR. Diabetes and surgery. A study of 667 cases. Am J Med. 1963; 34:177–91.
5. Goldmann DR. Surgery in patients with endocrine dysfunction. Med Clin North Am. 1987; 71:499–509.
6. Dagogo-Jack S, Alberti GM. Management of diabetes mellitus in surgical patients. Diabetes Spectr. 2002; 15:44–8.
7. Marks JB. Perioperative management of diabetes. Am Fam Physician. 2003; 67:93–100.
8. Hirsch IB, McGill JB, Cryer PE, White PF. Perioperative management of surgical patients with diabetes mellitus. Anesthesiology. 1991; 74:346–59.
9. American Diabetes Association. Standards of medical care in diabetes-2007. Diabetes Care. 2007; 30(Suppl 1):S4–41.
10. Glister BC, Vigersky RA. Perioperative management of type 1 diabetes mellitus. Endocrinol Metab Clin North Am. 2003; 32:411–36.
11. Plodkowski RA, Edelman SV. Pre-surgical evaluation of diabetic patients. Clinical diabetes. 2001; 19:92–5.
12. Schiff RL, Welsh GA. Perioperative evaluation and management of the patient with endocrine dysfunction. Med Clin North Am. 2003; 87:175–92.
13. Betts P, Brink S, Silink M, Swift PG, Wolfsdorf J, Hanas R. Management of children and adolescents with diabetes requiring surgery. Pediatr Diabetes. 2009; 10(Suppl 12):169–74.
14. Meneghini LF. Perioperative management of diabetes: translating evidence into practice. Cleve Clin J Med. 2009; 76(Suppl 4):S53–9.
15. Hoogwerf BJ. Perioperative management of diabetes mellitus: how should we act on the limited evidence? Cleve Clin J Med. 2006; 73(Suppl 1):S95–9.