Perioperative management of diabetes and corticosteroid supplementation

Diabetes is one of the most common endocrinopathies with increasing prevalence worldwide. More patients with severe diabetes require elective and emergency surgery. Diabetes is also associated with increased postoperative morbidity and mortality. It is essential that good glycaemic control is maintained to avoid complications related to both hyperglycaemia and hypoglycaemia. Historically, the means of achieving this has been variable, but there is now a large volume of data underlying recommendations for good glycaemic control. The Joint British Diabetes Societies for Inpatient Care Group, alongside other societies including Diabetes UK and the British Association of Day Surgery have provided updated guidance on the management of adults with diabetes undergoing surgery and elective procedures. The management of glycaemia in the intensive care setting is beyond the remit of this article. Ideally, all hospitals should have a diabetes consultant lead for this service and inpatient diabetes nurse teams to help facilitate optimal management. Corticosteroids are amongst the most common medications prescribed for variety of medical conditions. This can result in suppression of hypothalamic-pituitary-adrenal (HPA) axis and patients on corticosteroids are unable to mount an effective stress response to surgery. This article aims to give guidance and provide protocols for the effective perioperative management of diabetes and glucocorticoid replacement. Data on the need for supra-physiological corticosteroid doses are based on two small randomized controlled trials and other observational studies; highlighting the need for further research in this area.