An overview of preoperative glucose evaluation, management, and perioperative impact.
Perioperative hyperglycemia is a common phenomenon affecting patients both with and without a known prior history of diabetes. Despite an exponential rise in publications and studies of inpatient hyperglycemia over the last decade, many questions still exist as to what defines optimal care of these patients. Initial enthusiasm for tight glycemic control has waned as the unanticipated reality of hypoglycemia and mortality has been realized in some prospective studies. The recent dramatic modification of national practice guidelines to endorse more modest inpatient glycemic targets highlights the dynamic nature of current knowledge as the next decade approaches. This review discusses perioperative hyperglycemia and the categories of patients affected by it. It reviews current recommendations for ambulatory diabetes screening and its importance in preoperative patient care. Finally, it concludes with a review of current practice guidelines, as well as a discussion of future direction and goals for inpatient perioperative glycemic control.
Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53792, USA. asr@medicine.wisc.edu
Ann M
AM
Sheehy
Robert A
RA
Gabbay
D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D007003:Hypoglycemia / Q000097:blood / Q000139:chemically induced; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects; D007297:Inpatients; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects; D008403:Mass Screening / Q000379:methods; D019990:Perioperative Care; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011300:Preoperative Care; D018570:Risk Assessment; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects; D016896:Treatment Outcome
D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human