Diabetes, dysglycemia, and vascular surgery

Area of Science:

• Endocrinology
• Vascular Medicine
• Surgical Critical Care

Background:

• Glucose metabolism abnormalities, including chronic hyperglycemia and insulin resistance, are prevalent in patients with arterial disease.
• These metabolic issues complicate vascular disorders and are linked to adverse perioperative outcomes.

Purpose of the Study:

• To review the pathophysiologic effects of dysglycemia (abnormal blood glucose levels).
• To examine evidence supporting glycemic control in patients undergoing vascular surgery.
• To guide perioperative glucose management in this patient population.

Main Methods:

• Literature search for studies on hyperglycemia pathophysiology in microvascular and macrovascular beds.
• Inclusion of randomized trials in perioperative populations and meta-analyses.
• Synthesis of evidence to inform therapy for vascular surgery patients.

Main Results:

• No established national standards for glycemic control post-vascular intervention were found.
• Strong evidence links poor glycemic control to long-term vascular disease progression.
• Significant data supports tight hyperglycemia control in the perioperative period for general and cardiac surgery.

Conclusions:

• Hyperglycemia negatively impacts outcomes for vascular surgery patients.
• Further research is needed to define optimal perioperative serum glucose targets.
• Long-term glycated hemoglobin targets require investigation for vascular surgery patients.