Perioperative care of diabetic patients

Diabetes mellitus is the most common metabolic disease and its incidence is increasing. New classifications have been recently proposed based upon a b etter knowledge of pathogenesis, mechanisms of glucose transport and insuli n resistance. The perioperative care of diabetic patients is less dependent on blood-glucose control, which needs to be exceptionally tight, and is us ually easily obtained thanks to pharmacological improvements, human insulin s and analogues, technical progress with blood-glucose monitoring at the be dside and infusion with constant flow rates. More important is the influenc e of end-organ pathology, often clinically silent, which must be carefully assessed during the preoperative evaluation. The organ impairments concern especially the heart, but also all those organs that were modified by abnor mal glycosylated proteins. The pre-existing pathology has many consequences on anaesthesia management; the anaesthetic technique depends essentially o n their existence. A better long-term control of diabetes both for Type 1 a nd Type 2 by insulins, and the new oral anti-diabetic drugs reduce the inci dence of the endorgan pathology and the risk linked to organ failures in th e perioperative period.