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"Emergency medicine" №3(90), 2018

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The pathophysiological aspects of anesthetic management in patients with type 2 diabetes mellitus in the ambulatory practice

Authors: Іванюшко О.В.
Львівський національний медичний університет імені Данила Галицького, м. Львів, Україна

Categories: Medicine of emergency

Sections: Clinical researches

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Цукровий діабет набув характеру епідемії в усьому світі. Частота цукрового діабету 2-го типу швидко зростає серед представників усіх вікових груп і всіх рас. Ризики, пов’язані із седацією або загальною анестезією, у діабетиків є значними; отже, лікар при наданні амбулаторного наркозу зобов’язаний розуміти патофізіологію захворювання й знати загальні супутні захворювання. Потрібно з належною увагою підійти до вибору ефективної й безпечної анестезії для хворих на цукровий діабет при хірургічних втручаннях в амбулаторних умовах.

Сахарный диабет приобрел характер эпидемии во всем мире. Частота сахарного диабета быстро возрастает среди представителей всех возрастных групп и рас. Риски, связанные с седацией или общей анестезией, у диабетиков являются значительными; значит, врач при предоставлении амбулаторного наркоза обязан понимать патофизиологию болезни и знать общие сопутствующие заболевания. Следует с надлежащим вниманием подойти к выбору эффективной и безопасной анестезии для больных сахарным диабетом при хирургических вмешательствах в амбулаторных условиях.

Diabetes mellitus is an epidemic disease, its incidence in the world is increasing rapidly among all age groups and races. Each third person has pre-diabetes, therefore, in case of detection of hyperglycemia (often due to surgical stress), one should remember about the pre-diabetes. Accor­ding to national surveys, only 14 % of patients with diabetes do not have concomitant disease. Therefore, surgeons should take into account the fact that every tenth patient can potentially have diabetes. Obesity is an additional problem in anesthesia, including difficulties with breathing, ventilation, oxyge­nation; obstructive sleep apnea, gastroesophageal reflux disease, problem with dosage and delayed effect of the drug. The main causes of death of patients with type 2 diabetes mellitus are cardiovascular and atherosclerotic diseases, including acute cerebrovascular accident and coronary artery disease. Correct blood pressure control has a direct and significant impact on morbidity and mortality and is more important than blood glucose or lipid level control. Portable glucometer is a common way to determine the level of glucose in the blood. Liver diseases are the major cause of death in patients with type 2 diabetes mellitus. Compared with the general population, patients with type 2 diabetes mellitus have a higher level of liver diseases. Chronic kidney disease affect the pharmacokinetics of insulin, due to this fact, insulin-dependent patients have an increased risk of hypoglycemia. In diabetics with cardiovascular autonomic neuropathy confirmed by heart rate variability, the level of silent myocardial ischemia and mortality is two times higher. Thus, the anesthesiologist must understand the pathophysiology of diabetes mellitus and its common comorbidities. It is necessary to pay close attention to the choice of effective and safe anesthesia for patients with diabetes mellitus during surgical interventions in outpatient settings.


цукровий діабет 2-го типу; предіабет; гіперглікемія; гемоглобін A1c

сахарный диабет 2-го типа; предиабет; гипергликемия; гемоглобин A1c

type 2 diabetes mellitus; pre-diabetes; hyperglycemia; hemoglobin A1c

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1. Aldam P., Levy N., Hall G.M. Perioperative management of diabetic patients: new controversies // Br. J. Anaesth. — 2014. — 113(6). — 906-909.
2. American Diabetes Association. Standards of medical care in diabetes — 2013 // Diabetes Care. — 2013. — 36. — S11-S66.
3. Cefalu W.T. Glycemic targets and cardiovascular di–sease // N. Engl. J. Med. — 2008. — 358(24). — 2633-2635.
4. Centers for Disease Control and Prevention. Diabetes public health resource. — Atlanta, GA: Centers for Disease Control and Prevention, 2016. — Available from: www.cdc.gov/diabetes/statistics/prev/national/figpersons.html. — Accessed: June 2016.
5. Cryer P.E. Hypoglycemia, functional brain failure, and brain death // J. Clin. Invest. — 2007. — 117. — 868-870. 
6. Diagnosing diabetes and learning about prediabetes. — Ale–xandria, VA: American Diabetes Association, 2014. — Availa–ble from: http://www.diabetes.org/are-you-at-risk/prediabetes/. — Accessed: June 2016
7. Erden V., Basaranoglu G., Delatioglu H., Hamzaoglu N.S. Relationship of difficult laryngoscopy to long-term non-insulin-dependent diabetes and hand abnormality detected using the ‘prayer sign’ // Br. J. Anaesth. — 2003. — 91(1). — 159-160. 
8. Gastroparesis. — Alexandria, VA: American Diabetes Association, 2014. — Available from: http://www.diabetes.org/living-with-diabetes/complications/gastroparesis.html. — Accessed: August 2016.
9. Gastroparesis: introduction. — Baltimore, MD: Johns Hopkins Medicine, 2013. — Available from: http://www.hopkinsmedicine.org/gastroenterology_hepatology/pdfs/esophagus_stomach/gastroparesis.pdf. — Accessed: August 2016.
10. Global report ON DIABETES. — Washington, DC: World Health Organization, January 2016. — Available from: http://www.who.int/diabetes/global-report/en/. — Accessed: June 2016.
11. Hall J.E. Guyton and Hall Textbook of Medical Physio–logy. — 12th ed. — Philadelphia, PA: Saunders Elsevier, 2011.
12. Harris E.H. Elevated liver function tests in type 2 diabetes // Clin. Diabetes. — 2005. — 23(3). — 115-119.
13. Joshi G.P., Chung F., Vann M.A. et al. Society for Ambulatory Anesthesia consensus statement on preoperative blood glucose management in diabetic patients undergoing ambulatory surgery // Anesth. Anal. — 2010. — 11(6). — 1378-1387.
14. Koroshi A. Microalbuminuria, is it so important? // Hippokratia. — 2007. — 113. — 105-107.
15. Korpman T. Society of Ambulatory Anesthesia (SAMBA) on preoperative blood glucose management in diabetic patients undergoing ambulatory surgery; review of the consensus statement and additional commentary // CSA Bull. — 2010. — 58-62.
16. Liver function. — Charlottesville, VA: Johns Hopkins Medicine, 2015. — Available from: http://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_Diabetes_Guide/547086/all/Liver_function. — Accessed: August 2016.
17. Longnecker D.E., Brown D.L., Newman M.F., Zapol W.M. Anesthesiology. — 2nd ed. — New York, NY: McGraw Hill Medical, 2012.
18. Management of common comorbidities of diabetes. — Jacksonville, FL: American Association of Clinical Endocrinologists, AACE Diabetes Resource Center, 2016. — Available from: http://outpatient.aace.com/type-2-diabetes/management-of-common-comorbidities-of-diabetes. — Accessed: June 2016.
19. Mathioudakis N., Golden S.H. A comparison of inpatient glucose management guidelines: implications for patient safety and quality // Curr. Diabetes Rep. — 2015. — 15. — 13.
20. National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation. National diabetes statistics report, 2014. Estimates of diabetes and its burden in the United States. — Atlanta, Ga: Centers for Disease Control and Prevention, 2014. — Available from: www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf. — Accessed: June 1, 2016.
21. Plantinga L.C., Crews D.C., Coresh J. et al. Prevalence of chronic kidney disease in US adults with undiagnosed diabetes or prediabetes // Clin. J. Am. Soc. Nephrol. — 2010. — 5. — 673-682. 
22. Population estimates. — Washington, DC: US Department of Commerce, United States Census Bureau, 2016. — Avai–lable from: www.census.gov. — Accessed: June 2016.
23. Roberstshaw H.J., Hall G.M. Diabetes mellitus: anaesthetic management // Anaesthesia. — 2006. — 61. — 1187-1190.
24. Saha D.C., Choia I.S., Plauschinat C., Kwon J., Baron M. Impact of comorbid conditions and race/ethnicity on glycemic control among the US population with type 2 diabetes, 1988–1994 to 1999–2004 // J. Diabetes Complicat. — 2010. — 24(6). — 382-391. 
25. Scleredema. — Alphen aan den Rijn, the Netherlands: UpToDate, 2015. — Available from: http://www.uptodate.com/contents/scleredema. — Accessed: August 2016.
26. Sheehy AM, Gabbay RA. An overview of preoperative glucose evaluation, management, and perioperative impact // J. Diabetes Sci Technol. — 2009. — 6. — 1261-1269.
27. So… do І have prediabetes? — New York, NY: Ad Council, 2016. — Available from: https://doihaveprediabetes.org/index.html. — Accessed: June 2016.
28. Statistics about diabetes. — Alexandria, VA: American Diabetes Association, 2016. — Available from: www.diabetes.org/diabetes-basics/statistics/?loc=db-slabnav. — Accessed: June 2016.
29. The NICE-SUGAR Study Investigators. Intensive versus conventional glucose control in critically ill patients // N. Engl. J. Med. — 2009. — 360(13). — 1283-1297. 
30.  UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38 // BMJ. — 1998. — 317. — 703-713. 
31. Vann M.A. Perioperative management of ambulatory surgical patients with diabetes mellitus // Curr. Opin. Anaesthesiol. — 2009. — 22. — 718-724. 
32. Venkat K.K. Proteinuria and microalbuminuria in adults: significance, evaluation, and treatment // South Med. J. — 2004. — 97(10). — 969-979. 
33. Vink A.I., Maser R.E., Mitchell B.D., Freeman R. Diabetic autonomic neuropathy // Diabetes Care. — 2003. — 26. — 1553-1579.
34. Waikar S.S., Bonventre J.V. Creatinine kinetics and the definition of acute kidney injury // J. Am. Soc. Nephrol. — 2009. — 20(3). — 672-679. 

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