Abstract
Diabetic people are at risk of developing acute complications when exposed to stress. Surgery brings a stressful period when the patient is exposed not only to surgical stress but also the effects of medications used during that particular period. The patient’s comorbidities can influence the perioperative management of diabetes. Poorly controlled diabetes can complicate the hospital course.The literature was searched through PubMed and the articles of the last 5 years, from 2014 to 2019, were looked into. The studies available as a free text, in the English language and related to humans, were included. Inclusion criteria also included adults with type 2 diabetes undergoing surgery.The perioperative management of diabetes is a challenging one. Apart from the diabetes control; comorbidities, general health, intake, and interaction of medications both anti-diabetic and non-diabetic, type and duration of surgery, are some of the factors that influence the outcome of the surgery. With a variety of options available to manage diabetes currently, it is important to have a good insight into their effects to prevent complications to occur and ensure safe discharge from the hospital. The good control of diabetes is essential in bringing favorable outcomes.The perioperative management of diabetes should be individualized. Oral anti-hyperglycemic medications, other than sulfonylureas and SGLT2 inhibitors, provide a reasonable alternative to insulin and can be continued safely perioperatively depending upon the type of surgery and the patient is expected to resume oral intake soon postoperatively.
Highlights
BackgroundThe diabetic population is prone to have a complicated hospital course along with the risk of perioperative complications [1]
Hemoglobin A1c (HbA1c) provides an average estimate of blood sugars over the last three months in diabetic patients, thereby representing the quality of diabetic control and permits review and adjustment in treatment to achieve the target, in addition to that, its raised value in some studies indicates a likelihood of early postoperative infection and myocardial infarction [5,6]
It might be safe to restart 48 hours after the major procedure and making sure of the adequate functioning of the kidney Sulfonylurea The usual strategy to withhold it on the day of surgery remains plausible Dipeptidyl peptidase 4 (DPP4) inhibitors To continue or discontinue it perioperatively is unlikely to produce any significant complications and either strategy is acceptable Sodium–glucose co-transporters 2 (SGLT2) inhibitors At present, there is no agreement on the withholding of Sodium-Glucose Co-Transporters 2 (SGLT2) inhibitors before surgery but the general strategy is to stop them before 24–72 hours or even longer Glucagon-like peptide 1 (GLP1) agonists Gastrointestinal adverse effects may become limiting factors to their use
Summary
The diabetic population is prone to have a complicated hospital course along with the risk of perioperative complications [1]. Hemoglobin A1c (HbA1c) provides an average estimate of blood sugars over the last three months in diabetic patients, thereby representing the quality of diabetic control and permits review and adjustment in treatment to achieve the target, in addition to that, its raised value in some studies indicates a likelihood of early postoperative infection and myocardial infarction [5,6]. It has been found in the meta-analysis of studies involving patients with diabetes undergoing surgical procedures only that the blood sugar control in the range of 150-200 mg/dl (8.3-11.1 mmol/l) is associated with decreased perioperative mortality and stroke than a more relaxed target of > 200 mg/dl (11.1 mmol/l). The search of the literature review is done using the internet and PubMed using the following six regular keywords and three MeSH Words: Regular keywords
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