Peri-operative care: management of the diabetic patient. A novel controversy about tight glycemic control.
The peri-operative tight control of glycaemia for the diabetic patient is a matter of controversy. Diabetes per se is not a risk factor for post-operative morbidity or mortality, after adjustment for co-morbidities like atherosclerosis. Controlled studies have shown the advantages of tight control of glycaemia in two acute complications of atherosclerosis, i.e. myocardial infarction and cerebro-vascular accident. As these diseases have high prevalence in diabetes, and constitute the majority of post-operative problems of diabetic patients, when metabolic or infections are mastered, peri-operative tight control of glycaemia (6-10 mmol/l; 100-180 mg/dl) is presented as a probable necessity, when the pre-operative probability of macroangiopathy is high. This objective is best reached by a team associating anaesthesiologist and diabetologist, organising rules adapted to each hospital, including frequent capillary glycaemia controls and IV perfusions of glucose and insulin. Controlled clinical studies have to be done in this field.
Vanhaeverbeek
M
M
Laboratory Experimental Medicine, Montigny-le-Tilleul.
D000758:Anesthesia / Q000009:adverse effects; D001161:Arteriosclerosis / Q000150:complications; D001786:Blood Glucose / Q000378:metabolism*; D003920:Diabetes Mellitus / Q000097:blood* / Q000601:surgery*; D003925:Diabetic Angiopathies / Q000150:complications; D006801:Humans; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*
D001786:Blood Glucose