Perioperative management of diabetes

Diabetes is a highly prevalent, with serious peri-operative implications. Those with uncontrolled diabetes either preoperatively or postoperatively experience worse outcomes including increased morbidity and mortality. In this review, we aim to explore the appropriate glycemic targets both pre- and postoperatively based on available data. Management recommendations are provided for patients who were on insulin (including those on an insulin pump), on oral agents, and/or non-insulin injectables prior to surgery. Insulin remains the mainstay for management of hyperglycemia in the inpatient setting and recommendations are provided on dosing both for those previously on insulin and those newly initiated on it. Continued research into the best strategies for perioperative diabetes management is needed as many of our current recommendations are still based on empiric practices. However, in general, the data support optimizing glycemic management in the preoperative period to an HbA1c of <8.5% and in the postoperative period to between 140–180 mg/dL for optimal outcomes. Immediately preoperatively, patients should be advised to hold oral hypoglycemic and non-insulin injectables while both basal insulin should be reduced and bolus insulin held the day of surgery while patients are not permitted enteric intake.