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Management of the Perioperative Diabetic Patients

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Endocrinology & Metabolism".

Deadline for manuscript submissions: closed (30 November 2021) | Viewed by 14678

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Special Issue Editors

Prof. Dr. Benedikt Preckel

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Guest Editor

Department of Anesthesiology, Amsterdam University Centers, location AMC, University of Amsterdam, The Netherlands
Interests: cardiovascular anesthesia; organ protection; perioperative diabetes treatment; patient safety; cognitive aids; sedation outside the operating room; simulation
Special Issues, Collections and Topics in MDPI journals

Dr. Jeroen Hermanides

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Co-Guest Editor

Department of Anesthesiology, Amsterdam University Centers, location AMC, University of Amsterdam, Amsterdam, The Netherlands
Interests: perioperative diabetes treatment; perioperative metabolism; diabetes mellitus; epidemiology; allergy and anaphylaxis; neurometabolism

Special Issue Information

Dear Colleagues,

Diabetes mellitus is a growing concern worldwide: according to current projections, the prevalence will rise from 387 million people now to 592 million people in 2035 worldwide. Because diabetes mellitus is accompanied by macro- and microvascular complications, patients are more likely to be admitted to a hospital, which translates to a prevalence of diabetes mellitus in hospitalised patients of up to 40%. Furthermore, the annual risk of needing surgery is increased two to six fold in patients with diabetes mellitus as compared to patients without diabetes mellitus.

The association between hyperglycaemia and postoperative complications is firmly established in all surgical patients, including intensive care patients. Guidelines recommend blood glucose to be controlled below 10 mmol/L or even lower down to 7–8 mmol/L. However, implementation of strict perioperative glucose regulation is frequently hindered by low adherence to labour-intensive protocols requiring frequent blood glucose measurements and insulin administrations, as well as the risk of hypoglycaemia. Newer treatment options, like Glucagon-like peptide 1 receptor agonists or sodium-glucose cotransporter-2 inhibitors and others, have been introduced, and have positive effects not only on glycaemic control but also on cardiovascular morbidity.

There is need for future research to establish the optimized treatment of the surgical patient in the perioperative period, including a spectrum of patients ranging from ambulatory minor surgery to major abdominal and cardiac surgery along with intensive care treatment.

We invite experts in the field and research groups to contribute original research work as well as meaningful reviews to this Special Issue of Journal of Clinical Medicine on “Management of the perioperative diabetic patients”.

Prof. Dr. Benedikt Preckel
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

insulin resistance
stress hyperglycemia
glucagon-like peptide 1 receptor agonists
sodium-glucose cotransporter-2 inhibitors
metformin
insulin
continuous perioperative glucose monitoring
diabetes and coagulation
surgical site infections in diabetic patients
diabetes and neurometabolism

Published Papers (3 papers)

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Research

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11 pages, 1364 KiB

Open AccessArticle

Comparison of Microcirculatory Perfusion in Obese and Non-Obese Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass

by Chantal A. Boly, Margot Venhuizen, Nicole A. M. Dekker, Alexander B. A. Vonk, Christa Boer and Charissa E. van den Brom

J. Clin. Med. 2021, 10(3), 469; https://doi.org/10.3390/jcm10030469 - 26 Jan 2021

Cited by 4 | Viewed by 2212

Abstract

Obesity is a frequent comorbidity among patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Cardiac surgery with CPB impairs microcirculatory perfusion, which is associated with multiple organ failure. As microvascular function is frequently compromised in obese patients, we studied whether cardiac surgery with CPB has a more detrimental effect on microcirculatory perfusion in obese patients. Sublingual microcirculatory perfusion was measured with sidestream dark field (SDF) imaging in obese patients (body mass index ≥32 kg/m²; n = 14) without type II diabetes mellitus and in lean patients (BMI 20–25 kg/m²; n = 22) undergoing cardiac surgery with CPB. CPB reduced systolic blood pressure and mean arterial pressure more profoundly in lean compared with obese patients (SBP: 38% vs. 18%; MAP: 11% vs. 8%, p < 0.05), and both restored after weaning from CPB. No differences were present in intraoperative glucose, hematocrit, hemoglobin, lactate, and blood gas values between obese and lean patients. Microcirculatory perfusion did not differ between obese and lean patients the day before surgery. CPB decreased microcirculatory perfusion with 9% in both groups, but this was only significant in lean patients (p < 0.05). Three days following surgery, microcirculatory perfusion was restored in both groups. In conclusion, microcirculatory perfusion was equally disturbed during cardiac surgery with CPB in metabolically healthy obese patients compared to lean patients. Full article

(This article belongs to the Special Issue Management of the Perioperative Diabetic Patients)

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9 pages, 2876 KiB

Open AccessArticle

Effects of Liraglutide on Myocardial Function After Cardiac Surgery: A Secondary Analysis of the Randomised Controlled GLOBE Trial

by Abraham H. Hulst, Maarten J. Visscher, Thomas G. V. Cherpanath, Lieke van de Wouw, Marc B. Godfried, Bram Thiel, Bastiaan M. Gerritse, Thierry V. Scohy, R. Arthur Bouwman, Mark G. A. Willemsen, Markus W. Hollmann, J. Hans DeVries, Benedikt Preckel and Jeroen Hermanides

J. Clin. Med. 2020, 9(3), 673; https://doi.org/10.3390/jcm9030673 - 02 Mar 2020

Cited by 8 | Viewed by 2419

Abstract

Introduction: Previous studies demonstrated the cardioprotective properties of glucagon-like peptide-1 receptor agonists in patients with diabetes or cardiac disease. We investigated whether preoperative subcutaneous liraglutide improves myocardial function after cardiac surgery. Methods: We performed a pre-planned secondary analysis of adult patients undergoing cardiac surgery included in the GLOBE trial. Patients were randomised to receive 0.6 mg subcutaneous liraglutide on the evening before surgery and 1.2 mg after induction of anaesthesia, or matching placebo. Perioperative echocardiographic assessments, haemodynamic parameters, doses of vasoactive inotropic support and postoperative measurements of troponin, Creatine Kinase-MB , creatinine and lactate were compared between groups. Results: The study population consisted of the entire intention-to-treat cohort of the GLOBE trial. In this study, 129 patients received liraglutide and 132 patients placebo. Baseline characteristics were comparable between groups. Postoperatively, 170 (65%) patients underwent echocardiography. In the liraglutide group, more patients had a normal left ventricular systolic function (68%, 59 patients) compared to placebo (53%, 44 patients), difference = 15%, 95%CI = 0–30, p = 0.049. Assessment of the right ventricle revealed no difference in function. Conclusions: Patients receiving short-term preoperative liraglutide treatment better maintained normal myocardial function after cardiac surgery. This study warrants further evaluation of the potential beneficial effects of GLP-1 receptor agonists in cardiac surgery patients. Full article

(This article belongs to the Special Issue Management of the Perioperative Diabetic Patients)

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Review

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14 pages, 629 KiB

Open AccessReview

Effects of Hyperglycemia and Diabetes Mellitus on Coagulation and Hemostasis

by Xiaoling Li, Nina C. Weber, Danny M. Cohn, Markus W. Hollmann, J. Hans DeVries, Jeroen Hermanides and Benedikt Preckel

J. Clin. Med. 2021, 10(11), 2419; https://doi.org/10.3390/jcm10112419 - 29 May 2021

Cited by 38 | Viewed by 9187

Abstract

In patients with diabetes, metabolic disorders disturb the physiological balance of coagulation and fibrinolysis, leading to a prothrombotic state characterized by platelet hypersensitivity, coagulation disorders and hypofibrinolysis. Hyperglycemia and insulin resistance cause changes in platelet number and activation, as well as qualitative and/or quantitative modifications of coagulatory and fibrinolytic factors, resulting in the formation of fibrinolysis-resistant clots in patients with diabetes. Other coexisting factors like hypoglycemia, obesity and dyslipidemia also contribute to coagulation disorders in patients with diabetes. Management of the prothrombotic state includes antiplatelet and anticoagulation therapies for diabetes patients with either a history of cardiovascular disease or prone to a higher risk of thrombus generation, but current guidelines lack recommendations on the optimal antithrombotic treatment for these patients. Metabolic optimizations like glucose control, lipid-lowering, and weight loss also improve coagulation disorders of diabetes patients. Intriguing, glucose-lowering drugs, especially cardiovascular beneficial agents, such as glucagon-like peptide-1 receptor agonists and sodium glucose co-transporter inhibitors, have been shown to exert direct anticoagulation effects in patients with diabetes. This review focuses on the most recent progress in the development and management of diabetes related prothrombotic state. Full article

(This article belongs to the Special Issue Management of the Perioperative Diabetic Patients)

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