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The effective management of diabetes during the perioperative period is essential, given the increasing prevalence of diabetes mellitus and the subsequent rise in surgical procedures among individuals with diabetes. Maintaining optimal diabetes control before, during, and after any surgical procedure is paramount for preventing complications. In both diabetic and non-diabetic populations, hyperglycemia during the perioperative period serves as an independent marker of adverse surgical outcomes. In addition, hyperglycemia elevates morbidity and mortality risks, including delayed wound healing, an increased rate of infection, ICU admissions, prolonged hospital stays, and higher postoperative mortality. The stress induced by surgery, anesthesia, and illness leads to heightened secretion of counterregulatory hormones, such as cortisol, glucagon, growth hormone, and catecholamines. Consequently, this process reduces insulin secretion and peripheral glucose utilization, elevates insulin resistance, and increases lipolysis and proteolysis. This activity focuses on using diverse antidiabetic medicines, introduces strategies to achieve optimal glycemic targets, and underscores the significance of an interprofessional healthcare team approach in delivering care to diabetic patients during the perioperative period. This activity also provides healthcare professionals with the essential knowledge and tools to deliver optimal care for individuals with diabetes mellitus undergoing surgical procedures. Objectives: Identify diabetic patients at risk by recognizing key factors, such as type of diabetes, glycemic control, and susceptibility to hypoglycemia, during preoperative assessment. Assess the effectiveness of diverse antidiabetic medications and glycemic targets in preventing complications. Apply standardized protocols and algorithms to ensure accurate and timely adjustments to insulin regimens, considering individual patient needs. Collaborate with the interprofessional healthcare team to ensure coordinated and comprehensive care for diabetic patients throughout the perioperative period. Access free multiple choice questions on this topic.

Due to the increasing prevalence of diabetes mellitus and the subsequent rise in surgical procedures among individuals with diabetes, the effective management of the condition during the perioperative period is essential. Maintaining optimal diabetes control before, during, and after any surgical procedure is paramount for preventing complications. In both diabetic and non-diabetic populations, hyperglycemia during the perioperative period serves as an independent marker of adverse surgical outcomes. In addition, hyperglycemia elevates morbidity and mortality risks, including delayed wound healing, an increased rate of infection, intensive care unit (ICU) admissions, prolonged hospital stays, and higher postoperative mortality.[1][2][3][4] Hyperglycemia, defined as blood glucose levels exceeding 140 mg/dL, is a common phenomenon, with a prevalence ranging from 20% to 40% in general surgery and reaching 80% to 90% in the cardiac surgery population.[2][4][5][6] The stress induced by surgery, anesthesia, and illness leads to heightened secretion of counterregulatory hormones, such as cortisol, glucagon, growth hormone, and catecholamines.[7] Consequently, this process reduces insulin secretion and peripheral glucose utilization, elevates insulin resistance, and increases lipolysis and proteolysis. As a result, gluconeogenesis and glycogenolysis increase, which results in the exacerbation of hyperglycemia, commonly referred to as stress hyperglycemia. Uncontrolled hyperglycemia triggers osmotic diuresis, leading to fluid and electrolyte imbalance, ketogenesis, and heightened production of proinflammatory cytokines. This, in turn, results in mitochondrial injury, endothelial dysfunction, and immune dysregulation.[8][9] Hence, maintaining optimal glucose control in the perioperative period is associated with favorable postoperative outcomes.[4][5]

Interprofessional communication and care coordination among physicians of various specialties, including surgeons, anesthesiologists, hospitalists, endocrinologists, and primary care providers, along with nurses, pharmacists, nutritionists, and diabetes educators, are crucial for the optimal management of diabetes in patients during the perioperative period. Effective communication helps reduce adverse events, enhance clinical outcomes, and boost patient satisfaction. Formulating a structured plan tailored to individual patient needs is essential. Standardized protocols and computerized algorithms are crucial in reducing errors and delivering quality care to this patient population.[58] The patient and their family should consistently receive clear written and verbal instructions regarding modifications to the medication regimen both before and after the surgery. A safe transition from the inpatient to outpatient setting is crucial for effective diabetes management. The discharge plan should include medication reconciliation, patient education conducted by a healthcare professional, such as a doctor, pharmacist, or nurse, with expertise in diabetes education, evaluation of socioeconomic issues by case managers, and communication with an outpatient provider. If the pharmacist identifies concerns during medication reconciliation, they should be discussed with the healthcare team. The diabetic nurse educator ensures that the patient and their family comprehend the outpatient management plan. Any concerns about potential misunderstandings or lapses in follow-up should be communicated to the interprofessional team before discharge. A follow-up visit with the primary care provider or endocrinologist within 1 month of discharge from the hospital is advisable for all patients. An earlier appointment within 1 to 2 weeks if a change in medication or glycemic control was not optimal at discharge is preferred. Patients should receive prescriptions, drugs, and necessary medical equipment to help bridge care with their outpatient follow-up visits, and a coordinated interprofessional strategy is the best means to achieve this.[10]