Perioperative Management of the Patient with Diabetes

Diabetes mellitus is a common disease affecting 2–4% of the population. The prevalence of diabetes is predicted to double in the next decade due to increasing obesity. Many people in the community have unrecognized diabetes and it is not unusual for diabetes to be found incidentally when presenting with another illness. The World Health Organization (WHO) has recently revised the diagnostic criteria for diabetes (Figure 1). Surgery in people with diabetes is very common. Estimates suggest that 50% of patients with diabetes will undergo surgery at some time in their lives. Diabetes is a major risk factor for postoperative wound infections, but meticulous control substantially reduces this risk. Aggressive blood sugar normalization can improve outcome in critical illness.