Glycaemic control in the perioperative period

Area of Science:

• Anesthesiology
• Endocrinology
• Metabolic Disorders

Background:

• Increasing prevalence of type 2 diabetes mellitus and perioperative dysglycaemia presents significant clinical challenges.
• Existing research on perioperative glycaemic control primarily targets critically ill patients, with varying recommendations on insulin therapy and glucose targets.
• Gaps exist in understanding preoperative identification of undiagnosed diabetes, optimal intraoperative glucose goals, and the natural history of perioperative glucose dysregulation.

Purpose of the Study:

• To review current evidence and expert guidance on managing dysglycaemia in adult perioperative patients.
• To address the need for individualized glycaemic control strategies beyond critically ill populations.
• To provide a framework for preoperative assessment, intraoperative management, and postoperative care.

Main Methods:

• Systematic review of recent evidence and expert consensus on perioperative glycaemic control.
• Analysis of current guidelines and research findings related to glucose homeostasis in surgical patients.
• Synthesis of information to guide clinical decision-making for diverse adult perioperative populations.

Main Results:

• Perioperative glycaemic control strategies must be individualized due to patient heterogeneity.
• Further research is needed on preoperative screening, intraoperative glucose targets, and long-term outcomes of perioperative glucose abnormalities.
• Current guidelines suggest less stringent glucose control, but optimal targets remain debated.

Conclusions:

• A one-size-fits-all approach to perioperative glycaemic control is inadequate for the heterogeneous adult surgical population.
• Individualized management plans are essential, considering preoperative, intraoperative, and postoperative phases.
• Further investigation into undiagnosed dysglycaemia and the impact of perioperative glucose variability is warranted.