Skip to main content

Diabetes in the Pediatric Surgical Patient

  • Chapter
  • First Online:
Endocrine Surgery in Children

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. 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.

    Article  PubMed  Google Scholar 

  2. Craig ME, Hattersley A, Donaghue KC. Definition, epidemiology and classification of diabetes in children and adolescents. Pediatr Diabetes. 2009;10(Suppl 12):3–12.

    Article  PubMed  Google Scholar 

  3. Bolli GB, Fanelli CG. Physiology of glucose counterregulation to hypoglycemia. Endocrinol Metab Clin North Am. 1999;28(3):467–93.

    Article  CAS  PubMed  Google Scholar 

  4. 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.

    Article  CAS  PubMed  Google Scholar 

  5. Bingley PJ. Clinical applications of diabetes antibody testing. J Clin Endocrinol Metab. 2010;95(1):25–33.

    Article  CAS  PubMed  Google Scholar 

  6. 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.

    Article  PubMed  Google Scholar 

  7. 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.

    Article  Google Scholar 

  8. 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.

    Article  PubMed  Google Scholar 

  9. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33(Suppl 1):S62–9.

    Article  PubMed Central  Google Scholar 

  10. 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.

    Article  PubMed  Google Scholar 

  11. Bangstad HJ, Danne T, Deeb L, et al. Insulin treatment in children and adolescents with diabetes. Pediatr Diabetes. 2009;10(Suppl 12):82–99.

    Article  PubMed  Google Scholar 

  12. Mehta SN, Wolfsdorf JI. Contemporary management of patients with type 1 diabetes. Endocrinol Metab Clin North Am. 2010;39(3):573–93.

    Article  CAS  PubMed  Google Scholar 

  13. 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.

    Article  PubMed  Google Scholar 

  14. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. 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.

    Article  CAS  PubMed  Google Scholar 

  16. 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.

    Article  Google Scholar 

  17. 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.

    Article  Google Scholar 

  18. Sigal RJ, Kenny GP, Wasserman DH, et al. Physical activity/exercise and type 2 diabetes. Diabetes Care. 2004;27(10):2518–39.

    Article  PubMed  Google Scholar 

  19. 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.

    Google Scholar 

  20. Rosenbloom AL. Hyperglycemic hyperosmolar state: an emerging pediatric problem. J Pediatr. 2010;156(2):180–4.

    Article  PubMed  Google Scholar 

  21. Cruse PJ, Foord R. A five-year prospective study of 23,649 surgical wounds. Arch Surg. 1973;107(2):206–10.

    Article  CAS  PubMed  Google Scholar 

  22. Dronge AS, Perkal MF, Kancir S, et al. Long-term glycemic control and postoperative infectious complications. Arch Surg. 2006;141(4):375–80.

    Article  PubMed  Google Scholar 

  23. 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.

    Article  CAS  PubMed  Google Scholar 

  24. Rhodes ET, Ferrari LR, Wolfsdorf JI. Perioperative management of pediatric surgical patients with diabetes mellitus. Anesth Analg. 2005;101(4):986–99.

    Article  PubMed  Google Scholar 

  25. Bower WF, Lee PY, Kong AP, et al. Peri-operative hyperglycemia: a consideration for general surgery? Am J Surg. 2010;199(2):240–8.

    Article  CAS  PubMed  Google Scholar 

  26. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  27. 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.

    Article  CAS  PubMed  Google Scholar 

  28. 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.

    Article  PubMed  Google Scholar 

  29. Faustino EV, Apkon M. Persistent hyperglycemia in critically ill children. J Pediatr. 2005;146(1):30–4.

    Article  PubMed  Google Scholar 

  30. 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.

    Article  PubMed  Google Scholar 

  31. Tuggle DW, Kuhn MA, Jones SK, et al. Hyperglycemia and infections in pediatric trauma patients. Am Surg. 2008;74(3):195–8.

    PubMed  Google Scholar 

  32. 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.

    Article  PubMed  Google Scholar 

  33. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  34. 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.

    Article  CAS  PubMed  Google Scholar 

  35. 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.

    Article  CAS  PubMed  Google Scholar 

  36. 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.

    Article  PubMed  Google Scholar 

  37. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Preissig CM, Rigby MR, Maher KO. Glycemic control for postoperative pediatric cardiac patients. Pediatr Cardiol. 2009;30(8):1098–104.

    Article  PubMed  Google Scholar 

  39. 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.

    Article  PubMed  Google Scholar 

  40. 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.

    Article  PubMed  Google Scholar 

  41. 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.

    Article  PubMed  Google Scholar 

  42. 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.

    Article  CAS  PubMed  Google Scholar 

  43. 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.

    Google Scholar 

  44. 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.

    Article  PubMed  Google Scholar 

  45. 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.

    Article  PubMed  Google Scholar 

  46. 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.

    Article  PubMed  Google Scholar 

  47. 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.

    Article  CAS  PubMed  Google Scholar 

  48. 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.

    Google Scholar 

  49. 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.

    Article  PubMed  Google Scholar 

  50. Marik PE, Preiser JC. Toward understanding tight glycemic control in the ICU: a systematic review and metaanalysis. Chest. 2010;137(3):544–51.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  52. 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.

    Article  PubMed  Google Scholar 

  53. 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.

    Article  CAS  PubMed  Google Scholar 

  54. 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.

    Article  CAS  PubMed  Google Scholar 

  55. 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.

    Google Scholar 

  56. 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.

  57. 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.

  58. Krinsley JS, Grover A. Severe hypoglycemia in critically ill patients: risk factors and outcomes. Crit Care Med. 2007;35(10):2262–7.

    Article  PubMed  Google Scholar 

  59. 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.

    Article  PubMed  Google Scholar 

  60. 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.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Michael S. D. Agus .

Editor information

Editors and Affiliations

Rights and permissions

Reprints 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)

Publish with us

Policies and ethics