Diabetes mellitus: anaesthetic management

Area of Science:

• Endocrinology
• Surgical Medicine
• Diabetes Management

Background:

• Rising incidence of diabetes mellitus in the UK necessitates optimized peri-operative care for surgical patients.
• Both type 1 and type 2 diabetes require careful blood glucose management to improve surgical outcomes.

Purpose of the Study:

• To review evidence for peri-operative blood glucose control in diabetic patients undergoing surgery.
• To recommend a glucose-insulin-potassium (GIK) regimen for optimal peri-operative glycaemic management.

Main Methods:

• Literature review of studies on diabetes management in surgical settings.
• Analysis of evidence supporting blood glucose targets (< or = 10 mmol/L) in the peri-operative period.
• Guideline formulation for GIK regimen use in type 1 and type 2 diabetes.

Main Results:

• Evidence supports maintaining peri-operative blood glucose levels at or below 10 mmol/L for improved outcomes in both type 1 and type 2 diabetes.
• A glucose-insulin-potassium regimen is effective for peri-operative glycaemic control in type 1 diabetics.
• GIK regimen is recommended for type 2 diabetics undergoing moderate to major surgical procedures.

Conclusions:

• Strict peri-operative glycaemic control (< or = 10 mmol/L) significantly enhances surgical outcomes for diabetic patients.
• The glucose-insulin-potassium regimen is a key strategy for managing blood glucose in diabetic patients during the peri-operative period.
• Post-operative management should focus on reducing catabolic hormone response and facilitating early return to normal glycaemic control.