Newly Published
Clinical Focus Review  |   March 2020
Perioperative Management of Oral Glucose-lowering Drugs in the Patient with Type 2 Diabetes
Author Notes
  • From the Departments of Intensive Care (J.-C.P., B.P., W.M., K.H.) and Anesthesiology (K.H.), Erasmus Hospital, the Division of Endocrinology (M.C.), and the Center for Diabetes Research (M.C.), Free University of Brussels, Brussels, Belgium.
  • Submitted for publication August 30, 2019. Accepted for publication February 11, 2020.
    Submitted for publication August 30, 2019. Accepted for publication February 11, 2020.×
  • Correspondence: Address correspondence to Dr. Preiser: Department of Intensive Care, CUB-Erasme, Université Libre de Bruxelles (ULB), Route de Lennik, 808, 1070, Brussels, Belgium. jean-charles.preiser@erasme.ulb.ac.be. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Endocrine and Metabolic Systems / Clinical Focus Review
Clinical Focus Review   |   March 2020
Perioperative Management of Oral Glucose-lowering Drugs in the Patient with Type 2 Diabetes
Anesthesiology Newly Published on March 12, 2020. doi:https://doi.org/10.1097/ALN.0000000000003237
Anesthesiology Newly Published on March 12, 2020. doi:https://doi.org/10.1097/ALN.0000000000003237
Diabetes mellitus is a group of metabolic disorders, characterized by hyperglycemia, resulting from relative insulin deficiency, often on a background of insulin resistance (type 2 diabetes), or (near) absolute insulin deficiency related to autoimmune pathophysiology (type 1 diabetes). The most common form is type 2 diabetes, and its global prevalence is rising as a result of changes in lifestyle and lengthening of life expectancy.1,2  An estimated 463 million people aged 20 to 79 yr have diabetes,3  which corresponds to 9.3% of the adult population and represents a four-fold increase in diabetes prevalence since 1980.4  Patients with type 2 diabetes often have comorbidities such as arterial hypertension, obesity, ischemic heart disease, renal failure, and atherosclerosis. Ischemic heart disease in particular may affect younger patients compared to nondiabetic populations and may have silent ischemia. Hence, assessing the preoperative risk of diabetic patients is challenging, and can be underestimated. As shown outside the perioperative setting, these patients have equivalent or higher risk for cardiovascular events and mortality as patients with typical angina.5,6  However, current guidelines recommend against systematic stress testing in individuals without symptoms.7,8