Perioperative Management of Diabetes Mellitus Author: Nadia A. Khan, MD; William A. Ghali, MD; Susan E. Spratt, MD; Melanie E. Mabrey, MSN, ACNP, BC-ADM
Editorial changes - 2012-01-03
Author information and module status
Elements of Risk
Whom and How to Assess
Interventions to Decrease Risk
Patient Education
Follow-up

Tables
Figures
References
Glossary
What's New
Patient Information
Additional Resources
Tools
Additional Resources

Clinical Information
Guideline
   American Association of Clinical Endocrinologists/American Diabetes Association
 American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control
Article
   British Journal of Anaesthesia
 Clonidine premedication improves metabolic control in type 2 diabetic patients during ophthalmic surgery
   Circulation
 Inadequate blood glucose control is associated with in-hospital mortality and morbidity in diabetic and nondiabetic patients undergoing cardiac surgery
   Journal of the American Society of Nephrology
 Tight blood glucose control is renoprotective in critically ill patients
   New England Journal of Medicine
 Intensive insulin therapy in the medical ICU
 Clinical practice. Management of hyperglycemia in the hospital setting
Commentary
   ACP Journal Club
      Diabetes
 2007 - Intensive insulin therapy during cardiac surgery did not reduce mortality or morbidity but increased risk for stroke
      Diabetes mellitus
 2010 - Review: Statin use increases risk for diabetes
 2009 - Pioglitazone was associated with lower risk for adverse cardiovascular events than rosiglitazone in older patients
 2009 - A lifestyle intervention improved obstructive sleep apnea more than support and education in obese patients with diabetes
 2009 - A Mediterranean-style diet reduced need for glucose-lowering drugs more than a low-fat diet in type 2 diabetes
 2009 - Minimally invasive and conventional glucose monitoring did not differ for long-term glycemic control in insulin-treated diabetes
 2009 - Rosiglitazone was noninferior to metformin plus sulfonylurea for CV events but increased risk for HF and fractures in type 2 diabetes
 2009 - Review: Intensive glucose control reduced some CV events but did not change mortality in type 2 diabetes
 2009 - Bariatric surgery was cost-effective at 2 years for management of type 2 diabetes in obese patients
 2009 - Bariatric surgery was dominant over conventional therapy for lifetime management of type 2 diabetes in obese patients
 2008 - Review: Metformin reduces risk for CV mortality compared with other oral diabetes drugs or placebo in type 2 diabetes
 2008 - Intensive insulin therapy reduced long-term risk for incident hypertension in type 1 diabetes
 2008 - Benefits of early intensive glucose control to prevent diabetes complications were sustained for up to 10 years
 2008 - Benefits of tight blood pressure control to prevent diabetes complications were not sustained
 2008 - Glycemic control was not affected by self-monitoring of blood glucose in type 2 diabetes
 2008 - Self-monitoring of blood glucose was not cost-effective in non-insulin-treated type 2 diabetes
 2008 - Intensive insulin therapy improved glycemic control more than oral hypoglycemic agents in newly diagnosed type 2 diabetes
 2008 - Intensive glucose control did not prevent important complications in type 2 diabetes
 2008 - Intensive glucose control increased mortality and did not prevent cardiovascular events in type 2 diabetes
 2008 - Review: Little evidence exists on the benefits and harms of screening for and treating gestational diabetes
 2008 - A targeted, multifactorial intervention reduced mortality in patients with type 2 diabetes and microalbuminuria
 2008 - Adjustable gastric banding improved glycemic control in obese patients with type 2 diabetes
 2008 - Review: Statins prevent stroke and reduce mortality
 2007 - Thiazolidinediones increased risk for heart failure, myocardial infarction, and death in older patients with type 2 diabetes
 2007 - Aerobic plus resistance training was more effective than either alone for reducing HbA1c levels in type 2 diabetes
 - Review: Long-acting insulin analogues do not improve glycemic control but do reduce nocturnal hypoglycemia in diabetes
 2007 - Review: beta-blockers for hypertension increase risk for new-onset diabetes compared with nondiuretic antihypertensive agents
 2007 - Review: Thiazolidinediones increase congestive heart failure but not cardiovascular deaths in prediabetes or type 2 diabetes
 2007 - Self-monitoring of blood glucose did not improve glycemic control in patients with type 2 diabetes not treated with insulin
 2007 - Review: Incretin therapy improves glycemic control more than placebo in patients with type 2 diabetes
 2007 - Review: Thiazolidinediones increase risk for heart failure in type 2 diabetes
 2007 - Impaired fasting glucose and impaired glucose tolerance, as well as known diabetes, increased risk for death within 5 years
 2007 - Review: Meglitinide analogues reduce glucose levels in type 2 diabetes, but morbidity and mortality effects are unknown
 2007 - Review: Rosiglitazone increases risk for MI but does not differ from other drugs for CV death in type 2 diabetes
 2007 - Rosiglitazone increased heart failure but did not differ from metformin plus sulfonylurea for other CV outcomes at interim analysis
 2007 - A portion-control plate was effective for weight loss in obese patients with type 2 diabetes mellitus
 2007 - Review: Long-acting insulin analogues reduce risk for hypoglycemia compared with NPH insulin in type 2 diabetes
 2007 - Vildagliptin was effective as add-on therapy in type 2 diabetes inadequately controlled with metformin monotherapy
 2007 - Intensive insulin therapy during cardiac surgery did not reduce mortality or morbidity but increased risk for stroke
 2007 - Review: Angiotensin-receptor blockers and angiotensin-converting enzyme inhibitors have the lowest risk for diabetes
 2007 - Vildagliptin was noninferior to rosiglitazone for glycemic control in type 2 diabetes but caused less weight gain
 2006 - A lifestyle intervention continued to prevent type 2 diabetes in high-risk patients after the program was stopped
 2006 - Review: Inhaled insulin provides better glycemic control than oral hypoglycemic agents but not better than subcutaneous insulin
 2006 - Sitagliptin improved glycemic control and beta-cell function in type 2 diabetes
 2006 - Simvastatin was cost-effective across a broad range of risk and age groups
 2006 - Rosiglitazone reduced type 2 diabetes but increased heart failure in patients with impaired glycemic control
 2006 - Ramipril did not reduce incident diabetes in patients with impaired glycemic control
 2006 - Review: ACE inhibitors and angiotensin-receptor blockers reduce diabetes in hypertension and other CV risk factors
 2006 - Atorvastatin did not prevent cardiovascular events in type 2 diabetes
 2006 - Adjunctive inhaled insulin before meals improved glycemic control more than adjunctive metformin in type 2 diabetes mellitus
 2005 - Intensive insulin therapy reduced cardiovascular disease in type 1 diabetes
 2005 - Review: Angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers prevent type 2 diabetes
 2005 - Candesartan prevented development of diabetes mellitus in heart failure
 2005 - Screening and active management reduced perinatal complications more than routine care in gestational diabetes
 2005 - Review: alpha-Glucosidase inhibitors improve glycemic control but have uncertain effects on patient-important outcomes in type 2 diabetes
 2005 - A lifestyle intervention or metformin prevented or delayed the onset of the metabolic syndrome in persons at risk
 2005 - Review: Mixed signals from trials concerning pharmacologic prevention of type 2 diabetes mellitus
 2004 - Review: Insulin monotherapy and insulin combined with oral hypoglycemic agents provide similar glycemic control
 2004 - Review: Short-acting insulin analogues reduce glycosylated hemoglobin more than regular human insulin but only in adults with type 1 diabetes
 2005 - Diuretic-based therapy reduced cardiovascular mortality in older patients with isolated systolic hypertension and diabetes
 2004 - A dietitian-led intervention reduced weight and waist circumference in obese patients with type 2 diabetes
 2004 - Review: Fluoxetine, orlistat, and sibutramine modestly reduce weight in type 2 diabetes
 2003 - Review: Metformin does not increase risk for lactic acidosis or increase lactate levels in type 2 diabetes
 2003 - Review: Interventions focusing on patient behaviors in provider-patient interactions improve diabetes outcomes
 2003 - Acarbose reduced the risk for cardiovascular disease and hypertension in impaired glucose tolerance
 - Review: Rosiglitazone or pioglitazone as add-on therapy is effective for glycemic control in type 2 diabetes
 2003 - Enalapril reduced the risk for new-onset diabetes in left ventricular dysfunction
 2003 - A counseling strategy was better than usual care for adopting and maintaining physical activity in type 2 diabetes
 2003 - Combining fasting plasma glucose and glycosylated hemoglobin improved the accuracy for detecting patients with diabetes
 2002 - Training in flexible intensive insulin management improved glycemic control and quality of life in type 1 diabetes
 2002 - Losartan reduced cardiovascular morbidity and mortality more than atenolol in patients with diabetes and essential hypertension
 2002 - Review: Metformin does not increase fatal or nonfatal lactic acidosis or blood lactate levels in type 2 diabetes mellitus
 2002 - A split regimen of regular insulin at dinner and NPH insulin at bedtime reduced nocturnal hypoglycemia in type 1 diabetes
 2002 - A lifestyle intervention or metformin prevented or delayed the onset of type 2 diabetes in persons at risk
 2001 - Review: Stress hyperglycemia after ischemic stroke indicates a greater risk for death in patients without diabetes
 2001 - Several simple rules predicted complications in high-risk patients with diabetes
 2001 - Cardiovascular events were increased in high cardiovascular risk patients with albuminuria
 2001 - Changes in diet and physical activity prevented type 2 diabetes mellitus in persons with impaired glucose tolerance
 2001 - Review: Self-management training in type 2 diabetes mellitus is effective in the short term
 2000 - Glyburide was as safe and effective as insulin in gestational diabetes
 2000 - Review: Self-monitoring does not improve blood glucose control in type 2 diabetes mellitus

Patient Information
Web
 ACP Foundation HEALTH TiPS: Diabetes
 American College of Surgeons: When You Need An Operation
 American Diabetes Association: Type 2 Diabetes
 American Diabetes Association: Type 1 Diabetes
 ACP Foundation HEALTH TiPS: Diabetes (Spanish)
FAQs | Patient Information
Melanie E. Mabrey, MSN, ACNP, BC-ADM has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Nadia A. Khan, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Susan E. Spratt, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. William A. Ghali, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Deborah Korenstein, MD, FACP, Co-Editor, PIER, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Richard B. Lynn, MD, FACP, Co-Editor, PIER, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.


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