Current Pharmaceutical Design

Title:Hyperglycemia and Perioperative Glucose Management

Volume: 18Issue: 38

Author(s):Andra E. Duncan

Affiliation:

Keywords:Hyperglycemia, diabetes, glucose management

Abstract: Hyperglycemia is associated with increased mortality and morbidity in critically ill patients. Surgical patients commonly develophyperglycemia related to the hypermetabolic stress response, which increases glucose production and causes insulin resistance. Althoughhyperglycemia is associated with worse outcomes, the treatment of hyperglycemia with insulin infusions has not provided consistentbenefits. Despite early results, which suggested decreased mortality and other advantages of “tight” glucose control, later investigationsfound either no benefit or increased mortality when hyperglycemia was aggressively treated with insulin. Because of these conflictingdata, the optimal glucose concentration to improve outcomes in critically ill patients is unknown. There is agreement, however, thathypoglycemia is an undesirable complication of intensive insulin therapy and should be avoided. In addition, the risk of increased glucosevariability should be recognized, because of the associated increased risk for worse outcomes. Patients with diabetes mellitus experiencechronic hyperglycemia and often require more intensive perioperative glucose management. When diabetic patients are evaluatedbefore surgery, appropriate management of oral hypoglycemic agents is necessary as several of these agents warrant special consideration.Current recommendations for perioperative glucose management from national societies are varied, but, most suggest that tight glucosecontrol may not be beneficial, while mild hyperglycemia appears to be well-tolerated.

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E. Duncan Andra, Hyperglycemia and Perioperative Glucose Management, Current Pharmaceutical Design 2012; 18 (38) .https://dx.doi.org/10.2174/138161212803832236