Perioperative glycemic control: what is worth the effort?

Diabetes mellitus and its related comorbidities present a growing challenge in perioperative medicine. And also largely independent from a history of diabetes, dysregulations of glucose homeostasis occur as part of the body's stress response. Dysregulations of glucose homeostasis, acute or chronic, are closely correlated with impaired prognosis in perioperative medicine. Treatment strategies remain somewhat controversial, as both the affliction and its correction have a blind side.

Anesthesia requires vigilant attention to diabetes-related comorbidities such as neuropathy, angiopathy, cardiopathy and immune dysfunction. Dysregulations of glycemia of any kind, in other words, hypoglycemia and hyperglycemia and fluctuations of blood glucose, should be avoided. Target glycemia remains a matter of discussion: moderate, achievable glycemic target below 180 or 150 mg/dl appears to be reasonable. Modern technical developments like continuous glucose measurement devices and computer-assisted control algorithms are under development, and will hopefully facilitate perioperative glycemic control in the future.

Literature clearly shows that leaving glycemic control out of focus is dangerous for the patient; efforts to control glycemia to a moderate target improve the patient's outcome.