Perioperative Glucose Control and Cardiovascular Complications of the Cardiac Patient

Unless a cure is found, the number of patients suffering from diabetes mellitus (OM) and its co-morbidities will continue to rise. According to the World Health Organization, a diabetes epidemic is already underway. In 1985, an estimated 30 million people worldwide suffered from diabetes. By 2000 that number reached 177 million. By 2025, researchers project that DM will affect roughly 300 million people and result in approximately 4 million deaths per year, many from cardiovascular complications.1

According to Boyle et al., the number of Americans who are diagnosed with DM is projected to increase 165%, from 11 million in 2000 to 29 million in 2050.²

An increasing number of diabetic patients are presenting for anesthesia and surgery, which may translate to greater numbers of surgical patients at risk for ischemic heart disease. While OM has long been considered to be a significant predictor of perioperative cardiovascular morbidity and mortality, recent studies indicate that hyperglycemia, rather than diabetes, is responsible for adverse clinical outcomes. These studies imply that hyperglycemia is an independent predictor of perioperative cardiovascular risk, and that aggressive treatment of hyperglycemia may significantly decrease complications of myocardial ischemia and infarction.