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Feature Article

Practical advice for perioperative management in diabetes

Rajini Jayaballa, Vincent W Wong

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Abstract

Patients with diabetes have increased risks of mortality and morbidity following surgery. Optimal management during the perioperative period may reduce the risk of adverse outcomes postoperatively. By working together as a team, the surgeon (or proceduralist), anaesthetist, GP and/or endocrinologist can ensure the best surgical outcomes for each patient.

Key Points

  • For patients with diabetes, the metabolic impacts of surgery, fasting and interruptions to usual therapy contribute to poor glycaemic control, which may result in increased length of hospital stay and risks of morbidity and mortality.
  • Prevention of hyperglycaemia as well as hypoglycaemia may reduce the risk of adverse outcomes for patients with diabetes undergoing surgery.
  • Clear instructions should be given to patients before their procedure regarding how their diabetes medications will need to be modified on or before the day of surgery.
  • More frequent monitoring of blood glucose levels should be performed during the perioperative period. Good discharge planning and early review of the patient’s diabetes control after surgery is recommended, especially if the glycaemic profile is erratic.
  • Effective communication between all clinicians involved in an individual patient’s care is important for ensuring good outcomes.

    Picture credit: © Lissart/iStockphoto. Model used for illustrative purposes only.

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