Perioperative blood glucose monitoring and control in major vascular surgery patients.
Diabetes mellitus (DM) is an independent predictor for morbidity and mortality in the general population, which is even more apparent in patients with concomitant cardiovascular risk factors. As the prevalence of DM is increasing, with an ageing general population, it is expected that the number of diabetic patients requiring surgical interventions will increase. Perioperative hyperglycaemia, without known DM, has been identified as a predictor for morbidity and mortality in patients undergoing surgery. Moreover, early studies showed that intensive blood-glucose-lowering therapy reduced both morbidity and mortality among patients admitted to the postoperative intensive care unit (ICU). However, later studies have doubted the benefit of intensive glucose control in medical-surgical ICU patients. This article aims to comprehensively review the evidence on the use of perioperative intensive glucose control, and to provide recommendations for current clinical practice. A systematic review was performed of the literature on perioperative intensive glucose control. Based on this literature review, we observed that intensive glucose control in the perioperative period has no clear benefit on short-term mortality. Intensive glucose control may even have a net harmful effect in selected patients. In addition, concerns on the external validity of some studies are important barriers for widespread recommendation of intensive glucose control in the perioperative setting. We propose that guidelines recommending intensive glucose control should be re-evaluated. In addition, moderate tight glucose control should currently be regarded as the safest and most efficient approach to patients undergoing major vascular surgery.
van Kuijk
J P
JP
Department of Vascular Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands.
Schouten
O
O
Flu
W J
WJ
den Uil
C A
CA
Bax
J J
JJ
Poldermans
D
D
D000368:Aged; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D003422:Critical Care; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D016903:Drug Monitoring; D019317:Evidence-Based Medicine; D005215:Fasting / Q000097:blood; D005951:Glucose Tolerance Test; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D007004:Hypoglycemic Agents / Q000009:adverse effects; D008875:Middle Aged; D019990:Perioperative Care; D017410:Practice Guidelines as Topic; D011236:Prediabetic State / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D011237:Predictive Value of Tests; D011300:Preoperative Care; D018570:Risk Assessment; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality
D001786:Blood Glucose; D007004:Hypoglycemic Agents