Insight Into the Perioperative Management of Type 2 Diabetes

Abstract

Diabetic people are at risk of developing acute complications when exposed to stress. Surgery brings a stressful period when the patient is exposed not only to surgical stress but also the effects of medications used during that particular period. The patient's comorbidities can influence the perioperative management of diabetes. Poorly controlled diabetes can complicate the hospital course. The literature was searched through PubMed and the articles of the last 5 years, from 2014 to 2019, were looked into. The studies available as a free text, in the English language and related to humans, were included. Inclusion criteria also included adults with type 2 diabetes undergoing surgery. The perioperative management of diabetes is a challenging one. Apart from the diabetes control; comorbidities, general health, intake, and interaction of medications both anti-diabetic and non-diabetic, type and duration of surgery, are some of the factors that influence the outcome of the surgery. With a variety of options available to manage diabetes currently, it is important to have a good insight into their effects to prevent complications to occur and ensure safe discharge from the hospital. The good control of diabetes is essential in bringing favorable outcomes. The perioperative management of diabetes should be individualized. Oral anti-hyperglycemic medications, other than sulfonylureas and SGLT2 inhibitors, provide a reasonable alternative to insulin and can be continued safely perioperatively depending upon the type of surgery and the patient is expected to resume oral intake soon postoperatively.

Präoperative Evaluation erwachsener Patientinnen und Patienten vor elektiven, nicht herz-thoraxchirurgischen Eingriffen

“…Sulfonylharnstoffe beeinflussen die Pathophysiologie des Diabetes mellitus durch eine Steigerung der Insulinsekretion und Proliferation der Beta-Zellen des Pankreas [ 112 ]. Sulfonylharnstoffe und -analoga sollten aus diesem Grund am Tag der Operation, bei Nüchternphasen oder akut eingeschränkten Organfunktionen auch noch früher, pausiert werden [ 113 ] E50 .…”

Foot surgery without anesthesia in diabetic patients with sensory neuropathy: A short series

“…The treatment regimen established to promote wound healing frequently involves foot surgery and, therefore anesthesia. Anesthesia, however, holds specific risks in diabetic patients (4). General anesthesia requires prolonged fasting (with increased safety margins due to gastroparesis) as well as temporary cessation of oral antidiabetic medication and switch to insulin-based therapy.…”

Intermittent Fasting before Laparotomy: Effects on Glucose Control and Histopathologic Findings in Diabetic Rats

“…Considering that diabetes is a very challenging condition in the perioperative period and uncontrolled blood glucose can lead to worse surgical outcomes [15], we hypothesized that IF before surgery could be a new tool to improve glucose metabolic endurance and control after surgical trauma in diabetic rats, since the preoperative period represents an opportunity to optimize glycemic levels and potentially decrease adverse events [16].…”