Current therapeutic agents and anesthetic considerations for diabetes mellitus

Abstract

As the incidence of diabetes mellitus (DM) continues to increase worldwide, more diabetic patients will be presented for surgery and anesthesia. This increase of DM is a consequence of the rise in new patients of type 2 DM, and is likely attributable to rapid economic development, improved living standards, aging population, obesity, and lack of exercise. The primary goal of management in DM is to delay, or prevent the macro- and microvascular complications by achieving good glycemic control. More understanding of the pathophysiology of DM has contributed to the advance of new pharmacological approaches. In addition to the conventional therapy for DM, glucagon-like peptide-1 (GLP-1) mimetics, dipeptidyl peptidase-4 (DPP-4) inhibitors, thiazolidinediones (TZDs), and insulin analogues are currently available effective hypoglycemic agents for the management of the patients with DM in the perioperative period and also consider the adverse effects of newly introduced agents that need more clinical observations.

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“…The increasing number of patients with diabetes mellitus (DM) makes the work of the anesthetist even more challenging during the perioperative period: hyperglycemia might occur in the perioperative period due to a combination of tissue insulin resistance and decreased insulin secretion [ 7 ]. In addition, general anesthesia might cause a dangerous increase or decrease of systemic or pulmonary pressure because of variations in heart rate and pulmonary flows.…”

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“…Therefore, even if these studies are postulated that insulin therapy is not harmful, and may even be beneficial, it remains unclear what targets of glycemic control are appropriate. It is definite that tighter control necessitates more insulinmediatedpotential harmful effects, and the risk for hypoglycemia increase [10].…”

“…In diabetic patients, surgery and trauma are associated with an increase in the secretion of catabolic hormones in the presence of relative insulin deficiency. Therefore, the aim of perioperative metabolic management should be targeted to avoid excessive hyperglycemia, hypoglycemia and loss of electrolyte such as potassium, magnesium and phosphate [10,11].…”