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J Perioper Pract 2022 Apr 21:17504589221091063. Epub 2022 Apr 21.

Beijing Aerospace General Hospital, Beijing, China.

A cataract in the eye is a major cause of vision loss in diabetic patients, which occurs earlier and develops faster than non-diabetic patients, and often requires surgery for treatment. However, diabetic patients undergoing cataract surgery have a higher risk of intraoperative and postoperative complications than non-diabetic patients. For diabetic patients undergoing any surgery, careful perioperative assessment and management are required to reduce postoperative complications and improve surgical outcomes. Read More

Front Surg 2022 24;9:828649. Epub 2022 Mar 24.

Department of General-, Oncologic- and Visceral Surgery, Clinic Ottakring, Vienna, Austria.

Background: Euglycemic diabetic ketoacidosis (EDKA) is a potentially life-threatening condition and a reported side effect of antidiabetic sodium-glucose-cotransporter-2-inhibitors (SGLT2-I). The analysis of the herein presented case and its management formed the incentive to prepare this multidisciplinary work and includes an overview about perioperative SGLT2-I-induced ketoacidosis.

Method: A PubMed search on relevant entries was conducted combining the terms "euglycemic diabetic ketoacidosis" AND "surgery. Read More

J Perioper Pract 2022 Mar 15:17504589211024409. Epub 2022 Mar 15.

Trauma and Orthopaedics Department, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK.

A knowledge of perioperative problems and complications is an important requirement for surgeons. Diabetic patients are a particular group of patients that are specifically at risk of problems. These risks are not only related to the underlying pathophysiological process associated with the disease, but can also occur secondarily to medications used to manage the condition and require careful monitoring, and is of increased importance in the perioperative period. Read More

Instr Course Lect 2022 ;71:27-51

Some of today's tough questions surrounding hip and knee arthroplasty involve modifiable risks, bilateral staging, physiotherapy, postoperative activity, venous thromboembolism and infection prophylaxis, pain management, and outpatient settings. The available literature is reviewed to provide answers to difficult questions facing the orthopaedic surgeon. Preoperative questions focus on patient selection, medical optimization, and appropriateness for outpatient surgery. Read More

Curr Pain Headache Rep 2022 May 28;26(5):365-377. Epub 2022 Feb 28.

Department of Anesthesiology and Perioperative Medicine, University of Wisconsin, Madison, WI, USA.

Purpose Of Review: Painful diabetic neuropathy (PDN) is a prevalent and debilitating condition, characterized by severe burning, tingling, and lancinating pain usually located in the distal lower extremities. In addition to manifesting with severe pain, PDN may also be associated with poor quality of life and sleep, mood disorders, burns, falls, and social withdrawal. The authors appraised the current body of literature for evidence on neuromodulation interventions for PDN. Read More

Diagnostics (Basel) 2022 Feb 19;12(2). Epub 2022 Feb 19.

Vascular Surgery Unit, AOUP Policlinico "P. Giaccone", 90127 Palermo, Italy.

Diabetic neuropathy and Peripheral Arterial Disease (PAD) are the main etiological factors in foot ulceration. Herein, we report our experience of diabetic foot ulceration (DFU) management, with an analysis of the relationship between the rate of lower extremity amputation, in persons with infected DFU, after revascularization procedures performed to prevent major amputation. This study highlights the role of different biomarkers, showing their usefulness and potentiality in diabetic foot ulcer management, especially for the early diagnosis and therapy effectiveness monitoring. Read More

J Cardiovasc Surg (Torino) 2022 Feb;63(1):13-19

Department of Vascular and Endovascular Surgery, Asklepios Clinic Langen, Goethe-University of Frankfurt, Langen, Germany.

Background: The purpose of this study was to define patient and anatomical factors associated with technical results specific to rotational atherectomy. Controversy exists surrounding appropriate utilization of atherectomy to treat femoral-popliteal atherosclerosis. Importantly, the existence of different atherectomy devices and lack of technical reports highlighting variables that impact outcomes obscures the ability to assess perioperative performance. Read More

J Endocr Soc 2022 Mar 28;6(3):bvac010. Epub 2022 Jan 28.

Departments of Medicine (Endocrinology, Diabetes and Clinical Nutrition) and Neurological Surgery, and Pituitary Center, Oregon Health & Science University, Portland, Oregon 97239, USA.

Patients with Cushing disease (CD) may present with both chronic and acute perioperative complications that necessitate multidisciplinary care. This review highlights several objectives for these patients before and after transsphenoidal surgery. Preoperative management includes treatment of electrolyte disturbances, cardiovascular comorbidities, prediabetes/diabetes, as well as prophylactic consideration(s) for thromboembolism and infection(s). Read More

J Card Surg 2022 Apr 29;37(4):937-940. Epub 2022 Jan 29.

Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.

Poor glycemic control, regardless of patients' diabetic status, is associated with worse outcomes after coronary artery bypass grafting. As a result, in the perioperative and postoperative setting, the use of insulin is recommended to maintain glucose levels below 180 mg/dl (10.0 mmol/L). Read More

Anesth Analg 2022 Jun 20;134(6):1215-1228. Epub 2022 Jan 20.

Pain Management, Anesthesiology Institute.

Background: Painful diabetic neuropathy (PDN) is one of the major complications of diabetes mellitus. It is often debilitating and refractory to pharmaceutical therapies. Our goal was to systematically review and evaluate the strength of evidence of interventional management options for PDN and make evidence-based recommendations for clinical practice. Read More

Ann Palliat Med 2021 Dec;10(12):12300-12309

Department of Burns and Plastic Surgery, the First Affiliated Hospital of Soochow University, Suzhou, China.

Background: Diabetic foot (DF) is one of the most serious complications of diabetes mellitus (DM). In some cases of DF, life-saving amputation is necessary. This study set out to investigate the situation of preoperative blood glucose management in patients with DF. Read More

Int J Surg 2022 Feb 4;98:106215. Epub 2022 Jan 4.

Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China; OUTCOMES RESEARCH Consortium, Cleveland, OH, USA. Electronic address:

Background: Preoperative carbohydrate drink is used to improve patients' comfort and recovery, but evidence remains limited in diabetic patients. Herein we investigated the effects of preoperative carbohydrate loading with individualized supplemental insulin regimen in diabetic patients undergoing gastrointestinal surgery.

Methods: A total of 63 adult patients with type 2 diabetes mellitus undergoing major gastrointestinal surgery were randomized to receive either carbohydrate loading with individualized supplemental insulin (Carbohydrate group) or routine management (Control group). Read More

Dtsch Arztebl Int 2021 09 17;118(38):629-636. Epub 2021 Sep 17.

Dept. for Anesthesiology and Intensive Care Medicine, University Hospital of the Friedrich-Schiller University Jena, Jena, Germany; German Center for Diabetes Research (DZD), Neuherberg, Germany; King´s College London, Department of Diabetes, School of Life Course Science, London, UK; Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Germany; Division IV (Diabetology, Endocrinology, Nephrology) of the Department of Internal Medicine at the University Hospital Tübingen, Germany; Practice for Diabetology and Endocrinology, Dr. Kielstein, Outpatient Healthcare Center Erfurt, Jena.

Background: 30-80% of patients being treated in intensive care units in the perioperative period develop hyperglycemia. This stress hyperglycemia is induced and maintained by inflammatory-endocrine and iatrogenic stimuli and generally requires treatment. There is uncertainty regarding the optimal blood glucose targets for patients with diabetes mellitus. Read More

Crit Care 2021 Nov 1;25(1):378. Epub 2021 Nov 1.

Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia.

Background: A high body mass index (BMI) has been associated with decreased mortality in critically ill patients. This association may, in part, relate to the impact of BMI on glycemia. We aimed to study the relationship between BMI, glycemia and hospital mortality. Read More

Anasthesiol Intensivmed Notfallmed Schmerzther 2021 Oct 26;56(10):679-690. Epub 2021 Oct 26.

Drug therapy, as well as diabetes technology, e.g. insulin pumps or sensor glucose measurement, have developed enormously in recent years. Read More

Anesth Prog 2021 10;68(3):180-187

Adjunct Assistant Professor of Clinical Dentistry, Division of Endodontics, Orthodontics and General Practice Residency, Herman Ostrow School of Dentistry of USC, Los Angeles, California.

The use of continuous insulin pump systems for effective management of glycemic control in the patient with type 1 diabetes mellitus (T1DM) is steadily increasing. Although the types of devices and their respective manufacturers vary, insulin pumps all utilize similar underlying concepts based on the delivery of exogenous insulin to patients with T1DM in manners that more closely approximate the normal biologic function and performance of the pancreas. As insulin pumps becomes more commonplace and their use more widespread, the sedation or anesthesia provider must ensure familiarity with the basic knowledge of pump function and the various perioperative management considerations. Read More

Transplant Proc 2021 Oct 13;53(8):2636-2639. Epub 2021 Sep 13.

Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, California.

Postoperative euglycemic diabetic ketoacidosis (euDKA) associated with sodium-glucose cotransporter-2 (SGLT2) inhibitor use has been well-documented and carries a Food and Drug Administration recommendation to hold SGLT2 inhibitors 3 to 4 days before a planned surgical procedure. Unfortunately, many surgical procedures, such as orthotopic heart transplant (OHT), are unplanned and unpredictable. With the increasing use of SGLT2 inhibitors in diabetic and non-diabetic heart failure patients, new challenges in patient management and perioperative risk have arisen. Read More

World J Diabetes 2021 Aug;12(8):1255-1266

Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, United States.

Prediabetes and diabetes are important disease processes which have several perioperative implications. About one third of the United States population is considered to have prediabetes. The prevalence in surgical patients is even higher. Read More

Neurosurgery 2021 10;89(Suppl 1):S9-S18

Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida, USA.

Background: Patient factors (increased body mass index [BMI], smoking, and diabetes) may impact outcomes after spine surgery. There is a lack of consensus regarding which factors should be screened for and potentially modified preoperatively to optimize outcome.

Objective: The purpose of this evidence-based clinical practice guideline is to determine if preoperative patient factors of diabetes, smoking, and increased BMI impact surgical outcomes. Read More

BMJ Open 2021 09 6;11(9):e044394. Epub 2021 Sep 6.

Universität Münster, Münster, UK.

Introduction: Diabetes is common (about 20 million patients in Europe) and patients with diabetes have more surgical interventions than the general population. There are plausible pathophysiological and clinical mechanisms suggesting that patients with diabetes are at an increased risk of postoperative complications. When postoperative complications occur in the general population, they increase major adverse events and subsequently increase 1-year mortality. Read More

J Foot Ankle Surg 2022 Jan-Feb;61(1):117-122. Epub 2021 Jul 3.

Attending Physician, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington DC. Electronic address:

Heel ulcerations are common complications seen in patients suffering from chronic conditions such as diabetes mellitus, peripheral vascular disease, and in bed ridden patients. When these systemic pathologies lead to heel ulcers, an increased risk of calcaneal osteomyelitis often significantly limits the benefits of conventional therapeutic interventions and increases risk of major lower extremity amputation. The Vertical Contour Calcanectomy (VCC) is a novel surgical procedure specific for the surgical management of these complex and often recalcitrant heel ulcerations. Read More

Mayo Clin Proc 2021 09 3;96(9):2407-2417. Epub 2021 Jul 3.

Mayo Clinic Evidence-based Practice Center, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.

Objective: To evaluate the effectiveness and adverse events of autologous platelet-rich plasma (PRP) in individuals with lower-extremity diabetic ulcers, lower-extremity venous ulcers, and pressure ulcers.

Patients And Methods: We searched multiple databases from database inception to June 11, 2020, for randomized controlled trials and observational studies that compared PRP to any other wound care without PRP in adults with lower-extremity diabetic ulcers, lower-extremity venous ulcers, and pressure ulcers.

Results: We included 20 randomized controlled trials and five observational studies. Read More

Med J Aust 2021 08 3;215(3):119-124. Epub 2021 May 3.

Cairns and Hinterland Hospital and Health Service, Cairns, QLD.

Objectives: To assess the quality of care for patients with diabetes in Queensland hospitals, including blood glucose control, rates of hospital-acquired harm, the incidence of insulin prescription and management errors, and appropriate foot and peri-operative care.

Design, Setting: Cross-sectional audit of 27 public hospitals in Queensland: four of five tertiary/quaternary referral centres, four of seven large regional or outer metropolitan hospitals, seven of 13 smaller outer metropolitan or small regional hospitals, and 12 of 88 hospitals in rural or remote locations.

Participants: 850 adult inpatients with diabetes mellitus in medical, surgical, mental health, high dependency, or intensive care wards. Read More

Br J Anaesth 2021 07 30;127(1):e5-e7. Epub 2021 Apr 30.

Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia.

Surg Endosc 2022 02 19;36(2):1536-1543. Epub 2021 Mar 19.

Department of Surgery, NorthShore University Health System, 2650 Ridge Ave, GCSI Suite B665, Evanston, IL, 60201, USA.

Background: The endoluminal functional lumen imaging probe (FLIP) can be used to obtain real-time measurements of the diameter (D), cross-sectional area (CSA), and distensibility of the pylorus before and after peroral pyloromyotomy (POP), an emerging endoscopic treatment for delayed gastric emptying. Our study aims to report our single-center experience in performing POP with FLIP measurements before and after pyloromyotomy.

Methods: A retrospective review of a prospectively maintained gastroesophageal database was performed. Read More

JBI Evid Implement 2021 Mar 24;20(1):72-86. Epub 2021 Mar 24.

Specialty Surgery.

Objectives: The objectives of this project were to conduct a retrospective healthcare records audit to determine the current compliance with evidence-based criteria regarding perioperative management of patients with diabetes; to identify barriers and facilitators to achieve compliance and develop strategies to address areas of non-compliance, and to implement evidence-based best practice recommendations for perioperative diabetic management and to assess the effectiveness of these strategies in improving compliance of perioperative diabetic management across five participating clinical areas in a large tertiary referral hospital.

Introduction: Type 2 diabetes is a frequent co-morbidity among inpatients. It affects up to 20% of the general surgical population. Read More

Foot Ankle Int 2021 Jul 25;42(7):902-909. Epub 2021 Feb 25.

Loyola University Health System, Maywood, IL, USA.

Background: Modern patient safety programs focus on medical optimization of patients prior to surgery, regional anesthesia when possible, and hospitalist-orthopedic co-management during the perioperative period.

Methods: Eighty-five consecutive patients with diabetes and multiple medical comorbidities underwent surgical reconstruction for acquired deformities secondary to Charcot foot arthropathy with circular ring fixation between 2016 and 2019. All patients participated in a standardized risk reduction program that included medical optimization prior to surgery, regional anesthesia whenever possible, and hospitalist-orthopedic co-management during the perioperative period. Read More

Diabetes Metab Res Rev 2021 10 19;37(7):e3439. Epub 2021 Feb 19.

Department of Endocrinology, the First Medical Center, Chinese PLA General Hospital, Beijing, China.

With the increased incidence of diabetes, the number of diabetic patients who require surgical treatment is also increasing. Unfortunately, practices in this area lack standardisation. The purpose of this multidisciplinary, evidence-based guidelines for perioperative blood glucose management is to provide a comprehensive set of recommendations for clinicians treating diabetes with different types of surgery. Read More

Neurosurg Rev 2021 Dec 16;44(6):3039-3046. Epub 2021 Feb 16.

Department of Neurology, The People's Hospital of Leshan, Baita Street 238#, Leshan, 614000, Sichuan province, China.

Diabetes is considered to be one of the important factors affecting the prognosis of patients undergoing carotid endarterectomy (CEA), but its effect on carotid stenting (CAS) has not been determined. We performed this analysis to evaluate the impact of diabetes mellitus (DM) on carotid stenting. Studies were searched in the MEDLINE, EMBASE, and Cochrane Library databases for all available studies comparing the outcomes of diabetic and nondiabetic patients who underwent CAS. Read More

Pain Med 2021 Dec;22(12):2896-2907

Mount Sinai Hospital, Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, Canada.

Objective: To assess the efficacy and safety of N-acetylcysteine in the treatment of chronic pain.

Methods: A systematic search was carried out until April 2020 for clinical studies of N-acetylcysteine in the management of any persistent or recurrent chronic pain condition for adults ≥ 18 years old. Risk of bias was assessed using the validated risk of bias tools. Read More