Oral antidiabetic drugs: preoperative stop or continue?

In recent years, a lot of concern about the use of oral antidiabetics has been raised. Several studies indicate an excess cardiovascular morbidity and mortality associated with the use of oral antidiabetics in the treatment of non-insulin dependent diabetes mellitus. Only recently, the identification of the KATP-channels and it's pivotal role in the phenomenon of ischemic preconditioning has lead to a clear explanation of these disturbing findings. The antagonism of KATP-channels by the sulphonylurea-class type of oral antidiabetics interferes with ischemic preconditioning. The question has been raised what to do with oral antidiabetics during the perioperative setting with it's additional burden imposed on the cardiovascular system. In this article the historical background, the phenomenon of ischemic preconditioning, the importance of KATP-channels and the working mechanism of the oral antidiabetics are highlighted. A few thoughts on the use of oral antidiabetics in the perioperative setting are developed and clinical conclusions drawn.