Abstract
Type 1 diabetes mellitus (T1DM) is one of the most common chronic diseases in children and is frequently encountered in pediatric surgical practice. The annual incidence of diabetes in the United States is about 1/4000 children, but the worldwide incidence varies markedly by geographic location and ethnicity. Diabetes will be encountered frequently in pediatric surgical practice, and familiarity with the principles of its pathophysiology, treatment, and potential complications is critical for providing optimal surgical care to these patients. Surgery in patients with diabetes is associated with a variety of special considerations and risks. Perioperative care of these patients requires an understanding of the pathophysiology and current treatment of this disease, which are reviewed in this chapter. Surgical planning, preoperative evaluation, and intraoperative and postoperative management are discussed in detail, including principles of glycemic control, insulin management, and nutrition. Relevant acute and chronic complications of diabetes are also discussed.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Dabelea D, Bell RA, D’Agostino RB Jr, et al. Incidence of diabetes in youth in the United States. JAMA. 2007;297(24):2716–24.
Craig ME, Hattersley A, Donaghue KC. Definition, epidemiology and classification of diabetes in children and adolescents. Pediatr Diabetes. 2009;10(Suppl 12):3–12.
Bolli GB, Fanelli CG. Physiology of glucose counterregulation to hypoglycemia. Endocrinol Metab Clin North Am. 1999;28(3):467–93.
Thunander M, Petersson C, Jonzon K, et al. Incidence of type 1 and type 2 diabetes in adults and children in Kronoberg, Sweden. Diabetes Res Clin Pract. 2008;82(2):247–55.
Bingley PJ. Clinical applications of diabetes antibody testing. J Clin Endocrinol Metab. 2010;95(1):25–33.
Betts P, Brink S, Silink M, et al. Management of children and adolescents with diabetes requiring surgery. Pediatr Diabetes. 2009;10(Suppl 12):169–74.
Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977–86.
Nathan DM, Cleary PA, Backlund JY, et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med. 2005;353(25):2643–53.
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33(Suppl 1):S62–9.
Rewers M, Pihoker C, Donaghue K, et al. Assessment and monitoring of glycemic control in children and adolescents with diabetes. Pediatr Diabetes. 2009;10(Suppl 12):71–81.
Bangstad HJ, Danne T, Deeb L, et al. Insulin treatment in children and adolescents with diabetes. Pediatr Diabetes. 2009;10(Suppl 12):82–99.
Mehta SN, Wolfsdorf JI. Contemporary management of patients with type 1 diabetes. Endocrinol Metab Clin North Am. 2010;39(3):573–93.
Miles HL, Acerini CL. Insulin analog preparations and their use in children and adolescents with type 1 diabetes mellitus. Paediatr Drugs. 2008;10(3):163–76.
Polonsky KS, Given BD, Hirsch L, et al. Quantitative study of insulin secretion and clearance in normal and obese subjects. J Clin Invest. 1988;81(2):435–41.
Holman RR, Paul SK, Bethel MA, et al. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008;359(15):1577–89.
UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet. 1998;352(9131):854–65.
UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352(9131):837–53.
Sigal RJ, Kenny GP, Wasserman DH, et al. Physical activity/exercise and type 2 diabetes. Diabetes Care. 2004;27(10):2518–39.
Salpeter SR, Greyber E, Pasternak GA, et al. Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus. Cochrane Database Syst Rev 2010;4:CD002967.
Rosenbloom AL. Hyperglycemic hyperosmolar state: an emerging pediatric problem. J Pediatr. 2010;156(2):180–4.
Cruse PJ, Foord R. A five-year prospective study of 23,649 surgical wounds. Arch Surg. 1973;107(2):206–10.
Dronge AS, Perkal MF, Kancir S, et al. Long-term glycemic control and postoperative infectious complications. Arch Surg. 2006;141(4):375–80.
Noordzij PG, Boersma E, Schreiner F, et al. Increased preoperative glucose levels are associated with perioperative mortality in patients undergoing noncardiac, nonvascular surgery. Eur J Endocrinol. 2007;156(1):137–42.
Rhodes ET, Ferrari LR, Wolfsdorf JI. Perioperative management of pediatric surgical patients with diabetes mellitus. Anesth Analg. 2005;101(4):986–99.
Bower WF, Lee PY, Kong AP, et al. Peri-operative hyperglycemia: a consideration for general surgery? Am J Surg. 2010;199(2):240–8.
Moghissi ES, Korytkowski MT, DiNardo M, et al. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Diabetes Care. 2009;32(6):1119–31.
Umpierrez GE, Isaacs SD, Bazargan N, et al. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab. 2002;87(3):978–82.
Branco RG, Garcia PC, Piva JP, et al. Glucose level and risk of mortality in pediatric septic shock. Pediatr Crit Care Med. 2005;6(4):470–2.
Faustino EV, Apkon M. Persistent hyperglycemia in critically ill children. J Pediatr. 2005;146(1):30–4.
Srinivasan V, Spinella PC, Drott HR, et al. Association of timing, duration, and intensity of hyperglycemia with intensive care unit mortality in critically ill children. Pediatr Crit Care Med. 2004;5(4):329–36.
Tuggle DW, Kuhn MA, Jones SK, et al. Hyperglycemia and infections in pediatric trauma patients. Am Surg. 2008;74(3):195–8.
Wintergerst KA, Buckingham B, Gandrud L, et al. Association of hypoglycemia, hyperglycemia, and glucose variability with morbidity and death in the pediatric intensive care unit. Pediatrics. 2006;118(1):173–9.
Palacio A, Smiley D, Ceron M, et al. Prevalence and clinical outcome of inpatient hyperglycemia in a community pediatric hospital. J Hosp Med. 2008;3(3):212–7.
Golden SH, Peart-Vigilance C, Kao WH, et al. Perioperative glycemic control and the risk of infectious complications in a cohort of adults with diabetes. Diabetes Care. 1999;22(9):1408–14.
Latham R, Lancaster AD, Covington JF, et al. The association of diabetes and glucose control with surgical-site infections among cardiothoracic surgery patients. Infect Control Hosp Epidemiol. 2001;22(10):607–12.
Falcao G, Ulate K, Kouzekanani K, et al. Impact of postoperative hyperglycemia following surgical repair of congenital cardiac defects. Pediatr Cardiol. 2008;29(3):628–36.
Polito A, Thiagarajan RR, Laussen PC, et al. Association between intraoperative and early postoperative glucose levels and adverse outcomes after complex congenital heart surgery. Circulation. 2008;118(22):2235–42.
Preissig CM, Rigby MR, Maher KO. Glycemic control for postoperative pediatric cardiac patients. Pediatr Cardiol. 2009;30(8):1098–104.
Ulate KP, Lima Falcao GC, Bielefeld MR, et al. Strict glycemic targets need not be so strict: a more permissive glycemic range for critically ill children. Pediatrics. 2008;122(4):e898–904.
Yates AR, Dyke PC 2nd, Taeed R, et al. Hyperglycemia is a marker for poor outcome in the postoperative pediatric cardiac patient. Pediatr Crit Care Med. 2006;7(4):351–5.
Duncan AE, Abd-Elsayed A, Maheshwari A, et al. Role of intraoperative and postoperative blood glucose concentrations in predicting outcomes after cardiac surgery. Anesthesiology. 2010;112(4):860–71.
Ouattara A, Lecomte P, Le Manach Y, et al. Poor intraoperative blood glucose control is associated with a worsened hospital outcome after cardiac surgery in diabetic patients. Anesthesiology. 2005;103(4):687–94.
O’Brien JE, Jr., Marshall JA, Tarrants ML, et al. Intraoperative hyperglycemia and postoperative bacteremia in the pediatric cardiac surgery patient. Ann Thorac Surg 2010;89(2):578–583; discussion 583–4.
Van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in the critically ill patients. N Engl J Med. 2001;345(19):1359–67.
Finfer S, Chittock DR, Su SY, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360(13):1283–97.
Annane D, Cariou A, Maxime V, et al. Corticosteroid treatment and intensive insulin therapy for septic shock in adults: a randomized controlled trial. JAMA. 2010;303(4):341–8.
Arabi YM, Dabbagh OC, Tamim HM, et al. Intensive versus conventional insulin therapy: a randomized controlled trial in medical and surgical critically ill patients. Crit Care Med. 2008;36(12):3190–7.
Brunkhorst FM, Engel C, Bloos F, et al. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med 2008;358(2):125–139.
Griesdale DE, de Souza RJ, van Dam RM, et al. Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data. CMAJ. 2009;180(8):821–7.
Marik PE, Preiser JC. Toward understanding tight glycemic control in the ICU: a systematic review and metaanalysis. Chest. 2010;137(3):544–51.
Preiser JC, Devos P, Ruiz-Santana S, et al. A prospective randomised multi-centre controlled trial on tight glucose control by intensive insulin therapy in adult intensive care units: the Glucontrol study. Intensive Care Med. 2009;35(10):1738–48.
Van den Berghe G, Wilmer A, Hermans G, et al. Intensive insulin therapy in the medical ICU. N Engl J Med. 2006;354(5):449–61.
Wiener RS, Wiener DC, Larson RJ. Benefits and risks of tight glucose control in critically ill adults: a meta-analysis. JAMA. 2008;300(8):933–44.
Vlasselaers D, Milants I, Desmet L, et al. Intensive insulin therapy for patients in paediatric intensive care: a prospective, randomised controlled study. Lancet. 2009;373(9663):547–56.
Agus MS, Steil GM, Wypij D, Costello JM, Laussen PC, Langer M, et al. SPECS study investigators. N Engl J Med 2012;367(13):1208–19. PMID:22957521.
Macrae D, Grieve R, Allen E, Sadique Z, Morris K, Pappachan J, Parslow R, et al. CHiP investigators. A randomized trial of hyperglycemic control in pediatric intensive care. N Engl J Med 2014;370(2):107–18. doi:10.1056/NEJMoa1302564. Erratum in: N Engl J Med 2014;370(15):1469. PMID:24401049.
Agus MS, Wypij D, Hirshberg EL, Srinivasan V, Faustino EV, Luckett PM, et al. HALF-PINT study investigators and the PALISI network. Tight glycemic control in critically Ill children. N Engl J Med 2017. doi:10.1056/NEJMoa1612348. [Epub ahead of print] PMID:28118549.
Krinsley JS, Grover A. Severe hypoglycemia in critically ill patients: risk factors and outcomes. Crit Care Med. 2007;35(10):2262–7.
Gandhi GY, Nuttall GA, Abel MD, et al. Intensive intraoperative insulin therapy versus conventional glucose management during cardiac surgery: a randomized trial. Ann Intern Med. 2007;146(4):233–43.
Betts P, Brink S, Silink M, et al. Management of children and adolescents with diabetes requiring surgery. Pediatr Diabetes. 2009;10(Suppl 12):169–74.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer-Verlag GmbH Germany
About this chapter
Cite this chapter
Wassner, A.J., Agus, M.S.D. (2018). Diabetes in the Pediatric Surgical Patient. In: Ledbetter, D., Johnson, P. (eds) Endocrine Surgery in Children. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-54256-9_15
Download citation
DOI: https://doi.org/10.1007/978-3-662-54256-9_15
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-662-54254-5
Online ISBN: 978-3-662-54256-9
eBook Packages: MedicineMedicine (R0)