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Perioperatives Management bei Diabetes mellitus

Diabetes mellitus – perioperative management

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Zusammenfassung

Die Prävalenz des Diabetes mellitus bei hospitalisierten erwachsenen Patienten liegt derzeit bei ca. 12–25% und steigt weiter an. Diabetiker sind chirurgische Risikopatienten, da eine schlechte Blutzuckereinstellung und diabetische Folgeerkrankungen (z. B. diabetische Nephro- und Neuropathie, atherosklerotische Gefäßerkrankung) mit einer erhöhten perioperativen Morbidität und Mortalität assoziiert sind. Diese Komorbiditäten müssen präoperativ erfasst werden, um mögliche Komplikationen (z. B. Nierenversagen) durch ein adäquates Monitoring und entsprechende Therapiemaßnahmen zu vermeiden. Die Blutzuckereinstellung im perioperativen Verlauf ist eine besondere Herausforderung, da es durch präoperative Therapieumstellung und Einsetzen des Postaggressionsstoffwechsels zu einer hyperglykämischen Blutzuckerentgleisung mit Komplikationen wie Elektrolytentgleisung, Exsikkose, Gerinnungsstörung und Gefäßverschluss kommen kann. Die Art der Diabetestherapie hängt wesentlich von der Schwere der Operation und der damit verbundenen Dauer der Rehabilitation ab. Therapieziele der Blutzuckereinstellung sind bislang nicht durch klinisch kontrollierte Studie validiert, sondern basieren auf pathophysiologischen Überlegungen und epidemiologischen Daten. Nach den Richtlinien der Deutschen Gesellschaft für Ernährungsmedizin sind perioperativ Blutzuckerwerte zwischen 80 und 145 mg/dl anzustreben.

Abstract

The prevalence of diabetes in hospitalized adults is conservatively estimated at 12–25% and rising. Poor glucose control and presence of diabetes complications (e.g. diabetic nephropathy, diabetic neuropathy, atherosclerosis) are commonly regarded as risk factors for perioperative morbidity and mortality. Thus it is crucial to determine diabetes comorbidities preoperatively in order to avoid perioperative renal and cardiovascular complications. Perioperative glycemic control is challenging due to preoperative changes in diabetes treatment and the effects of surgery-associated stress hyperglycemia. For patients in general surgical units, evidence for specific glycemic goals is based on epidemiologic and physiologic data rather than clinical trials. According to guidelines of the German Society of Nutrition, the approximation of normoglycemia is reasonable as long as hypoglycemia is avoided (suggested range for plasma glucose 80–145 mg/dL).

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Authors and Affiliations

  1. Chirurgische Klinik und Poliklinik, Campus Klinikum Großhadern, LMU-München, Marchioninistraße 15, 81377, München, Deutschland

    P. Rittler, W. Hartl & K. Jauch

  2. Medizinische Klinik II, Campus Großhadern, LMU-München, München, Deutschland

    U.C. Broedl & B. Göke

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  1. P. Rittler
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  2. U.C. Broedl
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  3. W. Hartl
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  4. B. Göke
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  5. K. Jauch
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Correspondence to P. Rittler.

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Rittler, P., Broedl, U., Hartl, W. et al. Perioperatives Management bei Diabetes mellitus. Chirurg 80, 410–415 (2009). https://doi.org/10.1007/s00104-008-1631-6

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