An overview of preoperative glucose evaluation, management, and perioperative impact

Abstract

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.

Figure 1.

Relationship of in-hospital hyperglycemia.

Figure 2.

Figure 2. Criteria used to screen for diabetes mellitus: ADA and USPSTF. BMI, body mass index; HDL, high-density lipoprotein; PCOS, polycystic ovarian syndrome. Adapted from Fleisher and colleagues and U.S. Preventive Services Task Force, with permission from Mayo Clinic Proceedings.