Correspondence  |   November 2017
In Reply
Author Notes
  • Emory University School of Medicine, Atlanta, Georgia (E.W.D.). elizabeth.w.duggan@emory.edu
  • (Accepted for publication July 26, 2017.)
    (Accepted for publication July 26, 2017.)×
Article Information
Correspondence
Correspondence   |   November 2017
In Reply
Anesthesiology 11 2017, Vol.127, 900-901. doi:10.1097/ALN.0000000000001846
Anesthesiology 11 2017, Vol.127, 900-901. doi:10.1097/ALN.0000000000001846
We would like to thank Drs. Gerlach and Tung for their thoughtful commentary regarding our article on perioperative glucose control.1  A large body of evidence has clearly established the association between hyperglycemia and increased risk of perioperative morbidity and mortality in patients with and without diabetes.2,3  The risk of complications in surgical patients experiencing stress hyperglycemia appears to be higher in nondiabetic patients than in diabetic patients.4,5  Randomized controlled trials examining cardiac surgery patients demonstrate better outcomes in nondiabetic patients when their blood glucose target is achieved versus diabetic patients controlled to the same glycemic range.6,7  However, patients labeled as “nondiabetic” often are undiagnosed diabetics or prediabetics,8  and those without a formal diagnosis of diabetes are much less likely to be treated with insulin when hyperglycemic versus their diabetic counterparts.9  This may confound our understanding of current data comparing diabetics to nondiabetics. We do not yet have conclusive evidence to determine best hyperglycemia treatment or prevention strategies during the perioperative period in general surgery patients; continued work is needed in both diabetic and nondiabetic cohorts. Stratification is expected to be complex and treatment targets are likely to be based not only on diabetic, prediabetic, and nondiabetic status, but also on type of surgery, acuity of illness, degree of hyperglycemia, and sensitivity to insulin.
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