Zaidi Syed Owais, Khan Yusra, Razak Bibi S, Malik Bilal Haider
Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA.
Pharmacy, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA.
Cureus. 2020 Feb 4;12(2):e6878. doi: 10.7759/cureus.6878.
Diabetic people are at risk of developing acute complications when exposed to stress. Surgery brings a stressful period when the patient is exposed not only to surgical stress but also the effects of medications used during that particular period. The patient's comorbidities can influence the perioperative management of diabetes. Poorly controlled diabetes can complicate the hospital course. The literature was searched through PubMed and the articles of the last 5 years, from 2014 to 2019, were looked into. The studies available as a free text, in the English language and related to humans, were included. Inclusion criteria also included adults with type 2 diabetes undergoing surgery. The perioperative management of diabetes is a challenging one. Apart from the diabetes control; comorbidities, general health, intake, and interaction of medications both anti-diabetic and non-diabetic, type and duration of surgery, are some of the factors that influence the outcome of the surgery. With a variety of options available to manage diabetes currently, it is important to have a good insight into their effects to prevent complications to occur and ensure safe discharge from the hospital. The good control of diabetes is essential in bringing favorable outcomes. The perioperative management of diabetes should be individualized. Oral anti-hyperglycemic medications, other than sulfonylureas and SGLT2 inhibitors, provide a reasonable alternative to insulin and can be continued safely perioperatively depending upon the type of surgery and the patient is expected to resume oral intake soon postoperatively.
糖尿病患者在面临压力时易发生急性并发症。手术会带来一段压力时期，在此期间患者不仅要承受手术应激，还要受到该特定时期所用药物的影响。患者的合并症会影响糖尿病的围手术期管理。糖尿病控制不佳会使住院过程复杂化。通过PubMed检索文献，并查阅了2014年至2019年过去5年的文章。纳入的研究需为英文、可免费获取全文且与人类相关。纳入标准还包括接受手术的2型糖尿病成年患者。糖尿病的围手术期管理具有挑战性。除了糖尿病控制外，合并症、总体健康状况、药物（包括降糖药和非降糖药）的摄入及相互作用、手术类型和持续时间等都是影响手术结果的一些因素。鉴于目前有多种控制糖尿病的方法，深入了解它们的作用对于预防并发症和确保患者安全出院很重要。良好控制糖尿病对于取得良好结果至关重要。糖尿病的围手术期管理应个体化。除磺脲类和SGLT2抑制剂外，口服降糖药可作为胰岛素的合理替代药物，根据手术类型和患者术后预计很快恢复口服摄入的情况，可在围手术期安全继续使用。
