Management of Diabetic Patients Undergoing surgery
M. Aurangzeb2011, Journal of Postgraduate Medical …
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Abstract
Diabetes reaches its peak incidence during the 5th decade of life, the time when the frequency of surgery is also greatest in the general population. Diabetic patients have an estimated 50% chance of undergoing surgery during their life time, and for them the risks ...
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The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.
The Management of Diabetes During Surgery
British Journal of Anaesthesia, 1979
Diabetes offers a serious bar to any kind of operation, and injuries involving open wounds, haemorrhage, or damage to the blood vessels are exceedingly grave in subjects of this disease. A wound in the diabetic patient will probably not heal while the tissues appear to offer the most favourable soil for the development of putrefaction and pyogenic bacteria. The wound gapes, suppurates, and sloughs. Gangrene readily follows an injury in diabetics, and such patients show terrible proneness to the low form of erysipelas, and cellulitis." (Treves, 1896.) The advent of insulin revolutionized the treatment of diabetic patients undergoing surgery, a revolution that was extended by the discovery of antibiotics. Nonetheless, in unpractised hands surgery can still be disastrous for diabetics in terms of both morbidity and mortality. Even in good centres surgery carries a significant mortality and morbidity. Wheelock and Marble (1971) reported a 3.7% mortality in a series of 2780 patients studied between 1965 and 1969, while Galloway and Shuman (1963) had a 3.6% mortality and 17.2% morbidity in 667 cases. In the same period Alieff (1969) reported a 13.2% mortality. In diabetics undergoing renal transplantation there was two to four times the mortality compared with nondiabetics (Kjellstrand et al., 1972). The major causes of mortality and morbidity were and still are myocardial disease and infection. Obviously these are important in non-diabetics as well as in diabetics, but in the latter, poor control of diabetes with its attendant disturbances of electrolyte and intermediary metabolism will inevitably exacerbate these problems. Myocardial infarction itself is more likely to be mortal in diabetics (Soler et al., 1974) while resistance to infection is diminished in poorly controlled diabetes (Bagdade, Nielson and Bulger, 1972). Wound healing is also said to be impaired. Diabetics undergoing surgery tend to be a highrisk group. Three-quarters or more-of surgical
Morbidity and mortality of diabetes with surgery
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The prevalence of Type 2 diabetes mellitus (T2DM) has increased; as a result the number of patients with T2DM undergoing surgical procedures has also increased. This population is at high risk of macrovascular (cardiovascular disease, peripheral vascular disease) or microvascular (retinopathy, nephropathy or neuropathy) complications, both increasing their perioperative morbidity and mortality. Diabetes patients are more at risk of poor wound healing, respiratory infection, myocardial infarction, admission to intensive care, and increased hospital length of stay. This leads to increased inpatient costs. The outcome of perioperative glycaemia management remains a significant clinical problem without a universally accepted solution. The majority of evidence on morbidity and mortality of T2DM patients undergoing surgery comes from the setting of cardiac surgery; there was less evidence on noncardiac surgery and bariatric surgery. Bariatric surgery is increasingly performed in patients ...
The surgical patient with diabetes mellitus
J Gen Intern Med, 1995
A pproximately six million people in the United States have known diabetes mellitus. An additional six million people may have undiagnosed diabetes mellitus. At least half of all diabetic patients will require surgery sometime during their lives. L In fact, diabetes mellitus sometimes first develops during the perioperative period. Although the risk of surgery among patients with diabetes has declined in recent years, surgery is still potentially more dangerous for the diabetic patient. 2
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ISRN Surgery, 2013
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Annals of The Royal College of Surgeons of England, 2012
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The diabetic postoperative mortality and morbidity (DIPOM) trial: rationale and design of a multicenter, randomized, placebo-controlled, clinical trial of metoprolol for patients with diabetes mellitus who are undergoing major noncardiac surgery
American Heart Journal, 2004
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Current Surgery Reports, 2013
Bariatric surgery was initially developed as a tool for weight reduction only, but it is gaining increasing popularity because of its remarkable effect on glucose metabolism in morbidly obese and less obese patients. Recent publications have shown the superiority of metabolic surgery over medical treatment for diabetes, creating a new field of clinical research that is currently overflowing in the medical community with outstanding high-quality data. Metabolic surgery is effective in treating diabetes, even in non-morbidly obese patients.
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Acta chirurgica iugoslavica, 2011
The goal of this article is to present the importance of diabetes mellitus as comorbidity in patients submitting to different surgical procedures. The results of numerous studies that have been presented here showed worst surgical outcome in patients with bad diabetes control. This review considers the elements for preoperative evaluation and preparation of these patients (former therapy, longterm metabolic control, micro and macrovascular complications etc). According to existing data, the goals for preoperative preparation and the regimes for their achievement have been defined. Also, the regimes for blood glucose controle during intraoperative and postoperative period have been evaluated in this article.
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Mortality in diabetic patients undergoing non-cardiac surgery: a 7-year follow-up study
Acta Anaesthesiologica Scandinavica, 2009
The prognosis of diabetic patients after non-cardiac surgery remains controversial. This study was designed to compare the long-term mortality between diabetic and non-diabetic control patients undergoing non-cardiac surgery and to evaluate the possible risk factors. We investigated 274 consecutive diabetic patients and 282 non-diabetic control patients who underwent non-cardiac surgery within 1 year in a tertiary care hospital in Finland. The control group was matched for the same type of operations. Patients were followed for up to 7 years on average. The main outcome measure was mortality within 7 years. Mortality both in the short-term postoperatively (< or =21 days) and in the long-term (up to 87 (1/2) months) was significantly higher in the diabetic patients compared with the non-diabetic group: 3.5 vs. 0% (P<0.05) and 37.2 vs. 15% (P<0.00001), respectively. The major causes of death among diabetic subjects were diseases of the cardiovascular system (56.8%) compared with non-diabetic patients (18.6%), P<0.0001. We found that diabetes mellitus per se is not a risk factor for post-operative mortality but a combination of variables had a significant effect on both short- and long-term mortality. Diabetic patients undergoing non-cardiac surgery had a significantly higher incidence of short-term post-operative and long-term mortality compared with non-diabetic subjects. We propose a model of predictors of death among diabetic individuals undergoing non-cardiac surgery within a 7-year follow-up. The majority of deaths were associated with cardiovascular diseases.
Preoperative Management of Diabetic Patients, an Overview
Journal of Pharmaceutical Research International
Glycemic control is critical in the perioperative setting, especially in diabetic patients. The consequences of surgical tension and anesthesia on blood sugar levels are distinct, and should be considered in order to maintain optimal glycemic control. Each stage of surgery presents its own set of challenges in terms of keeping glucose levels within the target range. Furthermore, there are some surgical conditions that necessitate specific glucose management protocols. Authors hope to highlight the most crucial factors to consider when developing a perioperative diabetic regimen, while still allowing for specific adjustments based on sound clinical judgement. Overall, by carefully managing glycemic control in perioperative patients, we may be able to reduce morbidity and mortality while improving surgical outcomes.
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