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Review
. 2019 Jun;32(3):398-404.
doi: 10.1097/ACO.0000000000000735.

Recent advances in diabetes treatments and their perioperative implications

Deniz Kuzulugil  1 , Gabrielle Papeix  2 , Judy Luu  1   3   4   5 , Ross K Kerridge  2   5
Affiliations
Review

Recent advances in diabetes treatments and their perioperative implications

Deniz Kuzulugil et al. Curr Opin Anaesthesiol. 2019 Jun.

Abstract

Purpose of review: The implications for perioperative management of new oral antihyperglycemic medications and new insulin treatment technologies are reviewed.

Recent findings: The preoperative period represents an opportunity to optimize glycemic control and potentially to reduce adverse outcomes. There is now general consensus that the optimal blood glucose target for hospitalized patients is approximately 106-180 mg/dl (6-10 mmol/l). Recommendations for the management of antihyperglycemic medications vary among national guidelines. It may not be necessary to cease all antihyperglycemic agents prior to surgery. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are associated with higher rates of ketoacidosis especially in acutely unwell and postsurgical patients. The clinical practice implications of new insulin formulations, and new systems for insulin delivery, are not clear. The optimal perioperative management of these will vary depending on local institutional factors such as staff skills and existing clinical practices. Improved hospital care delivery standards, quality assurance, process improvements, consistency in clinical practice, and coordinated multidisciplinary teamwork should be a major focus for improving outcomes of perioperative patients with diabetes.

Summary: Sulfonylureas and SGLT2i should be ceased before moderate or major surgery. Other oral antihyperglycemic therapies may be continued or ceased. Complex patients and/or new therapies require specialized multidisciplinary management.

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Figures

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References

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    2. This reference outlines the epidemiology of diabetes globally, including future projections, and provides some guidance on important components of system improvement initiatives.

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