Perioperative Optimization of Diabetic Patients: A Narrative Review

Abstract

Riddhi Rana, Priyansh Patel, Tanmay Prasad and Saumil H Shah

Background: Diabetes mellitus is increasingly encountered in patients undergoing elective and emergency surgery. Perioperative dysglycemia is associated with surgical site infection, delayed wound healing, prolonged hospitalization, metabolic instability, and increased postoperative morbidity.

Objective: To review the current evidence and provide a clinically practical overview of perioperative optimization of adult patients with diabetes mellitus.

Methods: A narrative review was conducted using publicly available literature from peer-reviewed journals, reviews, clinical guidance documents, and perioperative diabetes management resources indexed in PubMed, PMC, and related academic sources.

Results: Successful perioperative optimization requires preoperative risk stratification, review of glycemic control, rational medication adjustment, avoidance of both hyperglycemia and hypoglycemia, intraoperative glucose surveillance, and timely postoperative resumption of therapy. Particular caution is required with insulin therapy, sodium-glucose cotransporter-2 inhibitors, and patients at risk of diabetic ketoacidosis or delayed gastric emptying.

Conclusion: Perioperative care of diabetic patients should be individualized, protocol-driven, and multidisciplinary. Updated knowledge of modern antidiabetic therapies and perioperative glucose targets is essential to improve surgical outcomes and patient safety.

PDF