Perioperative glycemic control: an evidence-based review

Area of Science:

• Anesthesiology
• Endocrinology
• Critical Care Medicine

Background:

• Perioperative hyperglycemia is a known risk factor for increased morbidity and mortality.
• Intensive insulin therapy (IIT) has demonstrated benefits in various critical care settings, including reduced infections and improved survival post-cardiac surgery.
• Recent concerns regarding severe hypoglycemia and adverse events associated with IIT necessitate a re-evaluation of its safety and efficacy.

Purpose of the Study:

• To review the mechanisms and rationale for managing hyperglycemia with IIT in the perioperative period.
• To critically assess the existing evidence supporting the use of IIT in surgical patients.
• To discuss the implications of incorporating glycemic control targets into national quality benchmarks.

Main Methods:

• Literature review and evidence synthesis.
• Analysis of existing studies on intensive insulin therapy in perioperative and critical care settings.
• Discussion of safety concerns, including hypoglycemia and adverse events.

Main Results:

• Hyperglycemia is a significant risk factor in perioperative patients.
• Evidence supports IIT's benefits in specific populations, but recent safety concerns are prominent.
• Optimal glucose targets and patient subgroups for IIT remain unidentified.

Conclusions:

• Avoiding perioperative hyperglycemia is beneficial.
• The appropriate glucose target and subpopulations for IIT are not yet established.
• Inclusion of specific glucose targets in national quality benchmarks is premature due to potential harms.