Perioperative management of diabetes mellitus: how should we act on the limited evidence?

Patients with diabetes mellitus are at higher risk for complications from surgery than their nondiabetic counterparts. Evidence-based guidance on the perioperative management of diabetic patients is still very limited. Management is best guided by careful preoperative and postoperative consideration of diet, antidiabetic medication regimens, and the likelihood of specific complications of diabetes. Good postoperative glucose control reduces the risk of in-hospital death and shortens length of stay. Insulin is the mainstay of perioperative glucose management, and intensive insulin therapy (to a target blood glucose of 110 mg/dL or lower) improves a range of clinical outcomes in critically ill patients relative to less aggressive insulin strategies. There is little role for oral antidiabetic medications in the early postoperative phase.