Diabetic Perioperative Management

Excerpt

Due to the increasing prevalence of diabetes mellitus and the subsequent rise in surgical procedures among individuals with diabetes, the effective management of the condition during the perioperative period is essential. Maintaining optimal diabetes control before, during, and after any surgical procedure is paramount for preventing complications. In both diabetic and non-diabetic populations, hyperglycemia during the perioperative period serves as an independent marker of adverse surgical outcomes. In addition, hyperglycemia elevates morbidity and mortality risks, including delayed wound healing, an increased rate of infection, intensive care unit (ICU) admissions, prolonged hospital stays, and higher postoperative mortality. Hyperglycemia, defined as blood glucose levels exceeding 140 mg/dL, is a common phenomenon, with a prevalence ranging from 20% to 40% in general surgery and reaching 80% to 90% in the cardiac surgery population.

The stress induced by surgery, anesthesia, and illness leads to heightened secretion of counterregulatory hormones, such as cortisol, glucagon, growth hormone, and catecholamines. Consequently, this process reduces insulin secretion and peripheral glucose utilization, elevates insulin resistance, and increases lipolysis and proteolysis. As a result, gluconeogenesis and glycogenolysis increase, which results in the exacerbation of hyperglycemia, commonly referred to as stress hyperglycemia.

Uncontrolled hyperglycemia triggers osmotic diuresis, leading to fluid and electrolyte imbalance, ketogenesis, and heightened production of proinflammatory cytokines. This, in turn, results in mitochondrial injury, endothelial dysfunction, and immune dysregulation. Hence, maintaining optimal glucose control in the perioperative period is associated with favorable postoperative outcomes.