Diabetes Mellitus: Preoperative Concerns and Evaluation.

Area of Science:

• Anesthesiology
• Endocrinology
• Metabolic Disorders

Background:

• Diabetes mellitus is a significant contributor to adult morbidity, leading to severe complications such as blindness, renal dysfunction, cardiovascular events, and limb amputation.
• These diabetes-related morbidities can substantially influence perioperative anesthetic care and patient outcomes.
• Effective management of patients with diabetes, and even those with hyperglycemia without a diabetes diagnosis, is critical in the perioperative setting.

Purpose of the Study:

• To review preoperative considerations for managing patients with diabetes and hyperglycemia.
• To propose a pharmacotherapy plan for preoperative diabetes management.
• To discuss criteria for proceeding with or canceling surgery based on glycemic control.

Main Methods:

• This study is a review of existing literature and clinical guidelines.
• It synthesizes information on preoperative assessment and management strategies for diabetic patients.
• The review includes recommendations for pharmacotherapy adjustments and glycemic targets.

Main Results:

• Preoperative hyperglycemia poses risks that necessitate careful management.
• A structured approach to diabetes pharmacotherapy, including the potential use of subcutaneous insulin pumps, can help prevent hypoglycemia and hyperglycemia.
• Establishing clear guidelines for surgical decisions based on hemoglobin A1c and blood glucose levels is essential.

Conclusions:

• Optimal perioperative anesthetic care for patients with diabetes requires proactive management of glycemic control.
• The proposed pharmacotherapy plan and surgical decision-making criteria aim to improve patient safety and outcomes.
• Addressing preoperative hyperglycemia is vital for reducing surgical risks and complications.