Diabetes Mellitus Literature Review

According to Pontes et al. (2018), complementary exams, history of the patient, and physical examination are crucial in preoperative management, specifically glycosylated hemoglobin that contains a greater predictive value for problems that are associated with diabetes. Pontes et al. (2018) say that surgical planning is aimed at decreasing the period for fasting in addition to maintenance of routines of the patients. A patient who has Type 1 Diabetes mellitus is given insulin so as to avoid ketoacidosis and meet the physiological demands. and the characteristics of the surgical procedure. When the period of fasting involves the limitation to missing meals, the best option entails the modification and maintenance of the manner by which medications are mostly utilized. In case there is the prediction of longer fasting periods, varying rates of intravenous infusion of insulin needs to be utilized.

Preoperative management of patients with Diabetes mellitus is directed towards reducing fluctuations of glucose level in the blood and avoidance of hyperglycemia, hypoglycemia, including difficulties making it difficult to return to the usual routine. Vann (2009) gives a step-wise strategy that can be used for preoperative management of the ambulatory surgery patient with diabetes. Pain, nausea and vomiting prevention is paramount. Intermediate-action and, long-action insulin consumption in normal doses and the diet normality maintained or reduced by 20 to 30 percent in the scenario of frequent nocturnal (Vann, 2009). According to Dafogianni and Iraklianou (2016), preoperative diabetic management is dependent upon several indicators making them constitute processes that are complex. It is, therefore, preferable that this process is done by a multidisciplinary team. Perioperatively avoiding BG level fluctuations is as much significant as maintaining the levels of BG so low concerning their impacts on mortality in addition morbidity.

Optimal methods like intravenous insulin infusions may at sometimes be labor intensive and expensive and may not be a requirement in most scenarios. Jacober and Sowers (2008) say that clinical judgment is the key component when it comes to good preoperative treatment of the patient with diabetes mellitus. Polderman et al. (2016) say that owing to the increasing numbers of the sick infected with diabetes mellitus together with the increasing procedures on surgery done in an ambulatory setting, diabetes mellitus happens to be the most commodities that are encountered by patients having ambulatory surgery. According to Polderman (2015), preoperative ambulatory management of patients that have diabetes mellitus needs a unique approach that those undergoing major surgery because the procedures do not take a lot of time and stress response that result from surgery is minimal.

Uncontrolled diabetes has manifestations that are manifold and include postoperative infection, increased mortality, a risk of hyperglycemia, and poor wound healing. According to Leung and Ragbir-Toolsie (2017), there is a lot of literature that gives support to the role of control of diligent glucose on prevention of severe surgical outcomes but there remains a considerable debate about the optimal targets of glucose. Several organizations advocate for hypoglycemia avoidance and at the same time striving for enough glucose control in the period of preoperative. Leung and Ragbir-Toolsie (2017) say that these objectives can be attained with a proper preoperative evaluation, frequent monitoring of blood glucose, patients instructions that are clear, and utilization of strategies for insulin titration and initiation that are effective. Leung and Ragbir-Toolsie (2017) conclude that preoperative diabetes management needs coordination and communication amongst outpatient-givers, patients, and anesthesia and surgical staff.

According to Berhe et al. (2017), preoperative care has a challenging aspect of appropriate glycemic control. The management needs to have a guidance from a pre-operational control of glycemic, duration in addition to a type of the operation and patients' functional reserve. Table for literature review Authors and Date of publication Sample/setting/design Data collection tools Findings/results Appraisal of evidence Level of evidence Paulo, 2016 Patients with diabetes mellitus Searched multiple databases like Medline via PubMed, Lilacs and the Cochrane library The research found that patients with diabetes mellitus have the higher risk of developing preoperative complications The research also found that metabolic stress that arises from the surgical procedure leads to hyperglycemia and decompensation Evidence on preoperative management is inadequate Level V Vann, 2009 Patients with diabetes mellitus undergoing ambulatory surgery Examined various evidence on glucose control, blood glucose fluctuations, and hyperglycemia effects The research found that that clinical judgment is the key component when it comes to good preoperative treatment of the patient with diabetes mellitus The evidence in this research is adequate Level V Dafogiani and Iraklianou, 2016 Patients with diabetic complications The study used a database search Perioperative management of diabetes is done well by teams of multidisciplinaries so that the requirements of all patients being covered either as individualism or holism.

The research has no enough evidence-based guidelines to be used for optimal preoperative management of patients with diabetes Level V Jacober and Sower, 2008 Patients with diabetes mellitus The study reviewed issues of intraoperative, preoperative, and postoperative care of patients with diabetes The study found that diabetes management is in most cases more art than clinical science The evidence in this research is adequate Level III Polderman,2015 Patients with diabetes The study reviewed the literature concerning anesthesiological management of patients who are infected with diabetes mellitus in the ambulatory setting. , & Iraklianou, S. Perioperative Management of Adult Patients with Diabetes Mellitus. International journal of caring sciences, 65(2), 79-102. Jacober, S.  J. Perioperative management of diabetes. American Family Physician, 44(2), 57-70. Polderman, J. , Van Wilpe, R.