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Expired CME Article

Perioperative Glucose Control in the Diabetic or Nondiabetic Patient

Dawn D. Smiley, MD, Guillermo E. Umpierrez, MD, FACP, FACE
Volume: 99 Issue: 6 June, 2006

Abstract:

Patients with diabetes are more likely to undergo surgery than nondiabetics, and maintaining glycemic control in subjects with diabetes can be challenging during the perioperative period. Surgery in diabetic patients is associated with longer hospital stay, higher health care resource utilization, and greater perioperative mortality. In addition, several observational and interventional studies have indicated that hyperglycemia is associated with adverse clinical outcomes in surgical and critically ill patients. This paper reviews the pathophysiology of hyperglycemia during trauma and surgical stress and will provide practical recommendations for the preoperative, intraoperative, and postoperative care of diabetic patients.


Key Points


* The comprehensive operative risk assessment is an important step in the management of the diabetic patient before surgery.


* Surgery in diabetic patients is associated with longer hospital stay, higher health care resource utilization, and greater perioperative mortality than in nondiabetic subjects.


* Increasing evidence suggests that in hospitalized medical as well as surgical patients with and without diabetes, the presence of hyperglycemia is associated with poorer clinical outcomes and aggressive glycemic control positively impacts morbidity and mortality.


* Treatment recommendations are generally categorized based on the type of diabetes, nature and extent of the surgical procedure, antecedent pharmacological therapy, and state of metabolic control prior to surgery.


* All patients with diabetes should receive continued diabetes education and the outpatient treatment regimen should be reviewed prior to discharge.

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