Perioperative management of adult diabetic patients. Review of hyperglycaemia: definitions and pathophysiology.

Gaëlle Cheisson, Sophie Jacqueminet, Emmanuel Cosson, Carole Ichai, Anne-Marie Leguerrier, Bogdan Nicolescu-Catargi, Alexandre Ouattara, Igor Tauveron, Paul Valensi, Dan Benhamou

Journal: Anaesthesia, critical care & pain medicine 2019;37 Suppl 1():S5-S8

PMID: 29559408

Free Full Text on Elsevier Science View on PubMed

Abstract

Diabetes mellitus is defined by chronic elevation of blood glucose linked to insulin resistance and/or insulinopaenia. Its diagnosis is based on a fasting blood-glucose level of ≥1.26g/L or, in some countries, a blood glycated haemoglobin (HbA1c) level of >6.5%. Of the several forms of diabetes, type-2 diabetes (T2D) is the most common and is found in patients with other risk factors. In contrast, type-1 diabetes (T1D) is linked to the autoimmune destruction of β-pancreatic cells, leading to insulinopaenia. Insulin deficiency results in diabetic ketoacidosis within a few hours. 'Pancreatic' diabetes develops from certain pancreatic diseases and may culminate in insulinopaenia. Treatments for T2D include non-insulin based therapies and insulin when other therapies are no longer able to control glycaemic levels. For T1D, treatment depends on long (slow)-acting insulin and ultra-rapid analogues of insulin administered according to a 'basal-bolus' scheme or by continuous subcutaneous delivery of insulin using a pump. For patients presenting with previously undiagnosed dysglycaemia, investigations should determine whether the condition corresponds to pre-existing dysglycaemia or to stress hyperglycaemia. The latter is defined as transient hyperglycaemia in a previously non-diabetic patient that presents with an acute illness or undergoes an invasive procedure. Its severity depends on the type of surgery, the aggressiveness of the procedure and its duration. Stress hyperglycaemia may lead to peripheral insulin resistance and is an independent prognostic factor for morbidity and mortality.

Address: Department of surgical anaesthesia and intensive care, South Paris university hospital, hôpital de Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France.; Institute of cardiometabolism and nutrition, Department of diabetes ad metabolic diseases, hôpital de la Pitié-Salpêtrière, AP-HP, 75013 Paris, France.; Department of endocrinology, diabetology and nutrition, hôpital Jean-Verdier (AP-HP), Paris 13 university, Sorbonne Paris Cité, CRNH-IdF, CINFO, 93140 Bondy, France; UMR U1153 Inserm, U1125 Inra, CNAM, Sorbonne Paris Cité, Paris 13 university, 93000 Bobigny, France.; Department of versatile intensive care, hôpital Pasteur 2, CHU de Nice, 30, voie Romaine, 06001 Nice cedex 1, France; Inserm U1081, CNRS UMR 7284 (IRCAN), University Hospital of Nice, 06001 Nice, France.; Department of diabetology and endocrinology, CHU de Rennes, hôpital Sud university hospital, 16, boulevard de Bulgarie, 35056 Rennes, France.; Department of endocrinology ad metabolic diseases, hôpital Saint-André, Bordeaux university hospital, 1, rue Jean-Burguet, 33000 Bordeaux, France.; Bordeaux university hospital, Department of Anaesthesia and Critical Care II, Magellan Medico-Surgical Centre, 33000 Bordeaux, France; Inserm, UMR 1034, Biology of Cardiovascular Diseases, université de Bordeaux, 33600 Pessac, France.; Department of endocrinology and diabetology, Clermont Ferrand university hospital, 58, rue Montalembert, 63000 Clermont-Ferrand, France; UFR médecine, Clermont Auvergne university, , 28, place Henri-Dunant, 63000 Clermont-Ferrand, France; UMR CNRS 6293, Inserm U1103, Genetic Reproduction and development, Clermont-Auvergne university, 63170 Aubière, France; Endocrinology-Diabetology, CHU G.-Montpied, BP 69, 63003 Clermont-Ferrand, France.; Department of endocrinology, diabetology and nutrition, hôpital Jean-Verdier (AP-HP), Paris 13 university, Sorbonne Paris Cité, CRNH-IdF, CINFO, 93140 Bondy, France.; Department of surgical anaesthesia and intensive care, South Paris university hospital, hôpital de Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France. Electronic address: [email protected].

DOI: 10.1016/j.accpm.2018.02.019