Peri-operative management of hyperglycemia in obese diabetic patients

The prevalence of overweight and obesity has increased to epidemic proportion across the globe. With it the prevalence of metabolic syndrome and type diabetes mellitus has also increased tremendously. Hyperglycemia as a consequence of associated type 2 diabetes mellitus, or stress response facilitated by counter-regulatory hormone surge is encountered quite commonly in obese patients during pre-operative assessment. There are reports of increased peri-operative complications with higher glucose levels in some studies, while evidence derived from some other studies are inconclusive. There are conflicting data regarding the benefit of a very tight intra-operative glucose control. There is clinical trial evidence that should help the operative team to develop some locally derived threshold near a reasonable blood glucose cut-off; for e.g., blood glucose level of 180 mg/dL for an elective major (i.e., requiring general anesthesia) procedure and 250 mg/dL for an emergency major or any sort of minor (not requiring general anesthesia) procedure.