الفهرس 
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Abstract
Hyperglycemia is a common and costly health care problem in hospitalized patients. Inadequate glycemic control in the surgical patients has been shown to increase morbidity and mortality in both diabetic and nondiabetic patients. Perioperative hyperglycemia is associated with longer hospital stay, higher health care resource utilization, and greater perioperative mortality and morbidity.
Compared to hyperglycemia due to diabetes, stress induced hyperglycemia is a particular challenge in inpatient care, as its prevalence and natural history are not well defined and its occurrence is unpredictable and often unanticipated by providers. Higher mortality was noted in patients without diabetes requiring insulin compared to patients with known diabetes suggesting that stress hyperglycemia may represent a different pathophysiology and natural history than in patients with known diabetes.
Diabetic patients are more likely to present as surgical patients with glycemic control challenges and are more often admitted to the intensive care unit. Mortality rates in diabetic surgical patients have been estimated to be up to 5 times greater than in nondiabetic patients. The higher morbidity and mortality in diabetic patients relates in part to end-organ damage caused by the disease and the heightened incidence of co morbid conditions and including coronary heart disease, hypertension, and renal insufficiency, as well as the adverse effects of hyperglycemia in clinical outcome. Diabetics have as much as a two to threefold greater frequency of cardiovascular disorders compared with the standard population.
Surgery produces a stress response that can be modified by anesthetic agents. Furthermore, anesthetics can affect glucose homeostasis perioperatively by decreasing catabolic hormone secretion. There are surgical and anesthetic techniques that can minimize the stress of surgery and therefore minimize the hyperglycemic response. These include minimally invasive surgeries and neuraxial anesthesia.
The ultimate goal in the management of perioperative hyperglycemia is to improve the clinical outcomrs and to achieve equivalent outcomes in diabetic patients is as those without diabetes mellitus. Optimization of the patient’s preoperative medications and the use of insulin infusions, as well as surgical and anesthetic technique, are important factors for achieving desirable perioperative blood glucose control. Minimizing blood glucose variability during surgery should be part of the glycemic control strategy. Advances in real-time glucose monitoring may benefit hospitalized diabetec and nondiabetic patients.
Balancing the risks of hypoglycemia against the known benefits in morbidity and mortality is the goal, and, although intensive glycemic control continues to be standard of care, current consensus guidelines recommend less stringent glycemic goals, typically between 80-150 mg/dL.