Perioperative management of diabetes and the emerging role of anaesthetists as perioperative physicians

Levy, N et al. British Journal of Anaesthesia. (2016) 116 (4):443-447.

Diabetes is the most common metabolic disorder and affects about 6–7% of the population and about 16% of the inpatient population. Diabetes leads to accelerated atherosclerosis and patients are at higher risk of renal impairment, coronary vascular disease, peripheral vascular disease and cerebro-vascular disease. Subsequently, the surgical patient with diabetes is at higher risk of perioperative morbidity and mortality and subsequently longer length of hospital stays. The reasons for this excess morbidity and mortality is multifactorial and includes increased risks of Hypoglycaemia and hyperglycaemia, infective complications (both surgical site infections (SSIs) and systemic infections), medical complications including acute kidney injury (AKI), acute coronary syndromes (ACS) and acute cerebro-vascular events, hospital acquired diabetic ketoacidosis (DKA),use of variable rate i.v. insulin infusion (VRIII), misuse of insulin, complex polypharmacy and multiple co-morbidities including microvascular and macrovascular complications of the diabetes.

On the basis of these concerns, NHS Diabetes commissioned the Joint British Diabetes Societies (JBDS) to produce guidance to optimise the management of the surgical patient with diabetes with the explicit aim of reducing the incidence of hypoglycaemia and hyperglycaemia, the risk of medical and infective complications, the risk of insulin and VRIII related harm and reducing the excess length of stay.

Read the abstract here


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