Brown DR

Language: English
References: 32
Page: 305-310
PDF size: 685.82 Kb.

Text Extraction

The term diabetes mellitus describes several syndromes of abnormal carbohydrate metabolism that are characterized by hyperglycemia. It is associated with a relative or an absolute impairment of insulin secretion, along with varying degrees of peripheral resistance to the metabolic effects of insulin. Diabetes is the most common endocrinopathy, occurring in nearly 10% of the general United States population and roughly one third of patients undergoing cardiac surgery. Given the increasing frequency of obesity, the number of diabetic patients has been projected to double in the next twenty years. Data showing an association between glycemic control and outcomes in hospitalized patients would suggest that glycometabolic regulation may have a profound impact on perioperative outcome. This review will discuss current classification and treatment of diabetes mellitus, the anesthetic implications of diabetes, as well as the available literature addressing glycemic control and outcomes in a variety of patient populations with recommendations for perioperative glycemic management.

REFERENCES

1. Genuth S, et al. Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care 2003; 26:3160.

2. Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 2007;30(supp 1):S42-47.

3. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993;329(14):977-86.

4. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998;352:837-53.

5. Krentz AJ, Bailey CJ. Oral antidiabetic agents. Drugs 2005;65:385-411.

6. Hirsch IB. Insulin analogues. N Engl J Med 2005;352:174-83.

7. Fleisher LA, et al. ACC/AHA 2007 Guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery. J Am Coll Cardiol 2007;50:159-242.

8. Magee MF, Bhatt BA. Management of decompensated diabetes. Crit Care Clin 2001;17:75-106.

9. Umpierrez GE, et al. Hyperglycemia: An independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab 2002;87:978-82.

10. Capes SE, et al. Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview. Stroke 2001;32:2426-32.

11. Capes SE, et al. Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet 2000;355:773-8.

12. Malmberg K, et al. Glycometabolic state at admission: Important risk marker of mortality in conventionally treated patients with diabetes mellitus and acute myocardial infarction. Circulation 1999;99:2626-32.

13. Van den Berghe G, et al. Intensive insulin therapy in critically ill patients. N Engl J Med 2001;345:1359-67.

14. Furnary AP, et al. Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg 2003;125:1007-21.

15. Kringsley JS. Association between hyperglycemia and increased hospital mortality in a heterogeneous population of critically ill patients. Mayo Clin Proc 2003;78:1471-8.

16. Kringsley JS. Effect of an intensive glucose management protocol on the mortality of critically ill adult patients. Mayo Clin Proc 2004;79:992-1000.

17. Van den Berghe G, et al. Intensive insulin therapy in the medical ICU. N Engl J Med 2006;354:449-61.

18. Van den Berghe G, et al. Intensive insulin therapy in mixed medical/surgical intensive care units: Benefit versus harm. Diabetes 2006;55:3151-9.

19. Available at: http://clinicaltrials.gov/ct/gui/show/NCT00107601. Accessed June 9, 2010.

20. Brunkhorst FM, et al. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med 2008;358:125-39.

21. The NICE-SUGAR Study Investigators. Intensive versus conventional glucose control in critically ill patients. N Engl J Med 2009;360:1283-97.

22. Doenst T, et al. Hyperglycemia during cardiopulmonary bypass is an independent risk factor for mortality in patients undergoing cardiac surgery. J Thorac Cardiovasc Surg 2005;130:1144-50.

23. Ouattara A, et al. Poor intraoperative blood glucose control is associated with a worse hospital outcome after cardiac surgery in diabetic patients. Anesthesiology 2005;103:687-94.

24. Gandhi GY, et al. Intraoperative hyperglycemia and perioperative outcomes in cardiac surgery patients. Mayo Clin Proc 2005;80:862-6.

25. McGirt MJ, et al. Hyperglycemia independently increases the risk of perioperative stroke, myocardial infarction, and death after carotid endarterectomy. Neurosurgery 2006;58:1066-73.

26. Malmstedt J, et al. Influence of perioperative blood glucose levels on outcome after infrainguinal bypass surgery in patients with diabetes. Brit J Surg 2006;93:1360-7.

27. D’Allesandro C, et al. Strict glycemic control reduces EuroSCORE expected mortality in diabetic patients undergoing myocardial revascularization. J Thorac Cardiovasc Surg 2007;134:29-37.

28. Ghandi GY, et al. Intensive intraoperative insulin therapy versus conventional glucose management during cardiac surgery. Ann Intern Med 2007;146:233-43.

29. Garber AJ, et al. American College of Endocrinology Position Statement on Inpatient Diabetes and Metabolic Control. Endocrine Practice 2004;10:77-82.

30. Kanji S, et al. Reliability of point-of-care testing for glucose measurement in critically ill adults. Crit Care Med 2005;33:2778-85.

31. Egi M, et al. Variability of blood glucose concentration and short-term mortality in critically ill patients. Anesthesiology 2006;105:244-52.

32. Available at: www.jointcommission.org/PerformanceMeasurement/PerformanceMeasurement/Current+NHQM+Manual. Accessed June 09, 2010.