Preoperative considerations for patients with diabetes

ABSTRACT

Introduction

Patients undergoing surgery require a thorough assessment preoperatively. Hyperglycemia is associated with poor outcomes, and stability of glucose levels is an important factor in preoperative management. Diabetes presents a particular challenge since patients are often on multiple medications encompassing glycemic management and cardiovascular therapies.

Areas Covered

A PubMed search of published data and reviews on preoperative approaches in diabetes was conducted. Consensus opinion drives most of the guidelines and recommendations for management of diabetes in surgical patients. Pathophysiology is often complex with varying levels of glucose and surgical stress. Establishing well-controlled diabetes prior to surgical intervention should be standard practice in non-emergent procedures. We review the best practices for implementing preoperative assessment, with diabetes with a focus on diabetes medications.

Expert opinion

The management of a patient preoperatively varies by region and country. Institutions differ in approaches to preoperative evaluation and the establishment of consistent approaches would provide a platform for monitoring patient outcomes. Multidisciplinary teams and pre-assessment clinics for preoperative evaluation can enhance patient care for those undergoing surgery.

KEYWORDS:

• Preoperative
• medication
• diabetes

Article highlights

• Early evaluation of the surgical patient is necessary to ensure optimal glucose control as metabolic decompensation is a risk for patients with diabetes undergoing surgery.

• Some diabetes medications require adjustment prior to and the day of surgery

• Preoperative care coordination is necessary to assure optimal patient care and outcomes that is best facilitated by preoperative preparation in a collaborative process

• The use of algorithms for assessing patient risk and dosing medications preoperatively is being studied

• Current and future trends on glycemic control and preoperative anesthesia management will likely include continuous glucose monitoring

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

The authors of this manuscript have no relevant financial or other relationships to disclose.

Authors contribution

J.K.K. and C.F.G. were involved in data interpretation and drafting the manuscript. All authors contributed to the manuscript write-up and have approved the final version. All authors agree to be accountable for all aspects of the work.

Additional information

Funding

This paper was not funded.