Management of Hyperglycemia and Diabetes in Orthopedic Surgery.

Existing Reviews

Please note, new claims can take a short while to show up.

No claims yet.

Annotation Summary

Term Occurence Count Dictionary
Insulin 1 endocrinologydiseasesdrugs
cortisol 1 endocrinologydiseasesdrugs
hyperglycemia 34 endocrinologydiseases
hypokalemia 1 endocrinologydiseases
obesity 2 endocrinologydiseases
diabetic foot 1 endocrinologydiseases
diabetic ketoacidosis 2 endocrinologydiseases
hypoglycemia 7 endocrinologydiseases
lactic acidosis 2 endocrinologydiseases
pioglitazone 1 endocrinologydiseasesdrugs

Graph of close proximity drug and disease terms (within 200 characters).

Note: If this graph is empty, then there are no terms that meet the proximity constraint.

Review

Having read the paper, please pick a pair of statements from the paper to indicate that a drug and disease are related.

Select Drug Character Offset Drug Term Instance
Insulin 30725 problems with sulphonylureas, it is likely that the use of these agents will become more widespread. Insulin infusions should continue until eating has resumed. On recommencing usual insulin treatment, the subcutaneous
cortisol 2376 response that produces marked neurophysiological changes with release of adrenaline, noradrenaline, cortisol , glucagon, and growth hormone. This increase in counter-regulatory hormones and cytokines raises glucose
pioglitazone 29855 which may be associated with hypoxia increasing the risk of lactic acidosis. Thiazolidinediones such as pioglitazone should not be restarted if significant fluid retention or congestive cardiac failure have developed
Select Disease Character Offset Disease Term Instance
diabetic foot 37117 increasing the fracture risk further. The orthopedic surgeon may also be involved in the management of diabetic foot emergencies depending on the local service setup.In the emergency setting, glycemic control remains
diabetic ketoacidosis 18939 electrolyte disturbance, and the diabetic emergencies of hyperosmolar hyperglycemic state (HHS) and diabetic ketoacidosis (DKA). The target range that is most effective in achieving these aims remains a matter of debate.The
diabetic ketoacidosis 26370 being taken down because of the short half-life of intravenous insulin in order to reduce the risk of diabetic ketoacidosis .PumpsFor people on continuous subcutaneous insulin infusion (insulin pumps) undergoing day case surgery,
hyperglycemia 419 whom the prevalence of diabetes is dramatically increasing. People having surgery with diabetes and hyperglycemia are at increased risk of post-operative complications. The peri-operative risks have been well demonstrated
hyperglycemia 734 issues surrounding orthopaedic surgery in patients with diabetes and the significance and management of hyperglycemia in the peri-operative period.IntroductionThe global prevalence and incidence of diabetes is steadily
hyperglycemia 1774 disease, renal impairment, and hypertension in patients with diabetes [[]]. Dysglycemia, which encompasses hyperglycemia , hypoglycemia, stress-induced hyperglycemia, and excessive glucose variability, is increasingly observed
hyperglycemia 1818 patients with diabetes [[]]. Dysglycemia, which encompasses hyperglycemia, hypoglycemia, stress-induced hyperglycemia , and excessive glucose variability, is increasingly observed and associated with poorer post-operative
hyperglycemia 2114 studies have shown post-operative complications occur more frequently in people with stress-induced hyperglycemia with no prior diagnosis of diabetes than in those with diabetes [[]–[]].Effect of Surgery on Glucose
hyperglycemia 2587 glucose levels and increases insulin resistance. In susceptible patients, this may result in significant hyperglycemia [[]]. Additionally, elements of the surgical process such as disturbed eating patterns due to fasting
hyperglycemia 4160 compared with 0.0%) [[]]. The incidence of surgical site infections has also been linked to peri-operative hyperglycemia in people without a prior diagnosis of diabetes. In this group, stress-induced hyperglycemia >200 mg/dL
hyperglycemia 4253 peri-operative hyperglycemia in people without a prior diagnosis of diabetes. In this group, stress-induced hyperglycemia >200 mg/dL (11.1 mmol/l) is an independent risk factor for surgical site infection at 30 days (OR
hyperglycemia 4538 Following trauma, a 7-fold increase in peri-operative infections has been seen with peri-operative hyperglycemia >220 mg/dL (12.2 mmol/l, P = 0.0056) [[]].Peri-prosthetic InfectionAlthough uncommon, occurring
hyperglycemia 5019 peri-operative HbA1c and peri-prosthetic infection at the hip or knee; however, both pre- and post-operative hyperglycemia have been associated with this serious complication [[]•, []]. Morning post-operative hyperglycemia
hyperglycemia 5121 hyperglycemia have been associated with this serious complication [[]•, []]. Morning post-operative hyperglycemia >140 mg/dL(7.8 mmol/L) is associated with a 3-fold increased risk of peri-prosthetic infection (27/285
hyperglycemia 6244 Management and Surgical OutcomesDespite the above associations, the key question is whether treating hyperglycemia reduces complications and improves these outcomes. There are no randomised studies in orthopedic surgery;
hyperglycemia 6486 observational study by Agos et al. demonstrated that implementation of an evidence-based standard to control hyperglycemia reduced the rate of surgical site infection in people undergoing hip and knee replacement surgery [[]••].Treating
hyperglycemia 6618 of surgical site infection in people undergoing hip and knee replacement surgery [[]••].Treating hyperglycemia in the peri-operative period has been shown to reduce complications in other surgical disciplines. Trussel
hyperglycemia 7202 targeted under 150mg/dL (8.3 mmol/L) [[]]. In general surgery, Umpierrez showed that lower rates of hyperglycemia , using a basal bolus regime, was associated with reduced incidence of wound infection, pneumonia, bacteremia,
hyperglycemia 7625 guidelines, the Joint British Diabetes Society (JBDS) guidelines, and others all advocating treatment of hyperglycemia for hospitalized patients peri-operatively [[]–[]]. The target glucose ranges for these guidelines
hyperglycemia 9362 1.01–1.66) for arthroplasty and 1.6 (CI 1.10–2.32) for spinal surgery after accounting for impact of hyperglycemia and adjusting for BMI [[]]. Interestingly, diabetes treated with insulin has been linked to increased
hyperglycemia 11252 admission, theater and recovery, and the post-operative period. The considerations of pumps, steroid-induced hyperglycemia , and emergency surgery are also discussed.Prehospitalization AssessmentSurgical OutpatientsIt is clear
hyperglycemia 13013 and 1.21 per mmol/L for glucose level, hinting that glycemic variability is at least as important as hyperglycemia this patient group [[]]. Although there are no prospective randomized trials demonstrating the impact
hyperglycemia 13726 lists with avoidance of elective evening surgery altogether [[]]. The regimen used to manage inpatient hyperglycemia also impacts on glucose variability, which is discussed later in this article.Accessible electronic
hyperglycemia 14688 should be considered. One prospective study of people undergoing elective noncardiac surgery found hyperglycemia in over 25% (118/493) of those without a prior diagnosis of diabetes on the morning of surgery [[]].Failure
hyperglycemia 14846 prior diagnosis of diabetes on the morning of surgery [[]].Failure to identify and manage diabetes and hyperglycemia pre-operatively has been shown to increase the risk of complications with higher requirement for resuscitation,
hyperglycemia 18824 Control and MonitoringThe aims of peri-operative glycemic control are avoiding hypoglycemia, marked hyperglycemia , electrolyte disturbance, and the diabetic emergencies of hyperosmolar hyperglycemic state (HHS) and
hyperglycemia 20600 complex operations and those with greater blood loss and through metabolic pathways, it contributes to hyperglycemia [[]]. A meta-analysis has shown insulin resistance may be attenuated by half with administration of
hyperglycemia 22312 [[]].With the aforementioned concerns about increased complication rates related to peri-operative hyperglycemia , the administration of carbohydrate drinks in people with diabetes requires further study before it
hyperglycemia 23609 neuropathy. Multidisciplinary team involvement is crucial in those who develop ulceration as resultant hyperglycemia in those with infected ulcers can create a vicious cycle by delaying wound healing.Theater and RecoveryGlucose
hyperglycemia 30567 demonstrated the safety and efficacy of DPP4 inhibitors, the gliptins, in people with mild to moderate hyperglycemia (200 mg/dl) [[]]. In view of the potential problems with sulphonylureas, it is likely that the use
hyperglycemia 31083 minimize the risk of DKA and glucose excursions.Treating HyperglycemiaFollowing surgery, management of hyperglycemia remains important both for people with diabetes and those with stress-induced hyperglycemia. Due to
hyperglycemia 31175 management of hyperglycemia remains important both for people with diabetes and those with stress-induced hyperglycemia . Due to its breadth of usability, insulin remains the main agent for controlling hyperglycemia for in-hospital
hyperglycemia 31270 stress-induced hyperglycemia. Due to its breadth of usability, insulin remains the main agent for controlling hyperglycemia for in-hospital patients, and can be used regardless of comorbidities or altered clinical states such
hyperglycemia 31790 not offer tighter glycemic control for hospitalized patients and are associated with higher rates of hyperglycemia than a range of other regimes without any significant reduction in length of hospital stay [[]]. Due
hyperglycemia 34606 from increased insulin resistance to direct effects on pancreatic beta cell function. The resulting hyperglycemia may be asymptomatic or result in osmotic symptoms and fatigue. It often resolves spontaneously, but
hyperglycemia 36155 to 4 times a day and to commence treatment for 2 consecutive glucose readings above 12 mmol/L. For hyperglycemia resulting from intra-articular steroid injection, as with multiple daily steroid doses, oral agents
hyperglycemia 36297 intra-articular steroid injection, as with multiple daily steroid doses, oral agents are unlikely to control the hyperglycemia , and a subcutaneous insulin regime is preferred. A pragmatic approach would be to commence basal insulin
hypoglycemia 1789 impairment, and hypertension in patients with diabetes [[]]. Dysglycemia, which encompasses hyperglycemia, hypoglycemia , stress-induced hyperglycemia, and excessive glucose variability, is increasingly observed and associated
hypoglycemia 18803 attention.Hospital AdmissionGlycemic Control and MonitoringThe aims of peri-operative glycemic control are avoiding hypoglycemia , marked hyperglycemia, electrolyte disturbance, and the diabetic emergencies of hyperosmolar hyperglycemic
hypoglycemia 19258 outside of the critical care or cardiology setting with increased mortality attributed to higher rates of hypoglycemia [[]]. The emphasis is increasingly on adapting the glycemic target to the individual patient and their
hypoglycemia 30184 as gliclazide may be withheld because of their insulin secretory effects with potential for causing hypoglycemia . A smaller dose may be initiated and titrated up as oral intake returns to normal. A cautious re-introduction
hypoglycemia 30430 considered where there has been a kidney injury, as reduced renal excretion can further augment and prolong hypoglycemia . Recent studies have demonstrated the safety and efficacy of DPP4 inhibitors, the gliptins, in people
hypoglycemia 32489 delirium or drowsiness secondary to concomitant analgesia following surgery. With its associated risks, hypoglycemia can be a barrier to intensifying glucose treatment.In the case of missed meals or interrupted nutrition,
hypoglycemia 32789 sulphonylureas and prandial insulin should be implemented locally to reduce the risk of iatrogenic hypoglycemia and standardize care.Specialist TeamsIt is increasingly common for elderly orthopedic patients to be
hypokalemia 10520 further exacerbated by nausea and vomiting caused by anesthetic agents. The result may be tachycardia, hypokalemia , and hypomagnesemia with the resulting arrhythmias contributing to the increased peri-operative cardiovascular
lactic acidosis 29430 for which clinical circumstances should be considered before reinstating. Metformin carries a risk of lactic acidosis , particularly in those with renal insufficiency. It should be omitted in patients who develop acute
lactic acidosis 29811 significant hepatic impairment, all of which may be associated with hypoxia increasing the risk of lactic acidosis . Thiazolidinediones such as pioglitazone should not be restarted if significant fluid retention or congestive
obesity 8715 associated with greater surgical risk because of the higher incidence of co-morbid conditions, including obesity , sleep apnea, hypertension, in addition to the micro- and macrovascular complications that are associated
obesity 28914 dosing is not widely practiced in the UK or recommended in the guidance; however, the additional risk of obesity is considered in the dosing advice in Australian and US guidance. The American Association of Surgeons

You must be authorized to submit a review.