Perioperative hyperglycaemia and its treatment in patients with diabetes mellitus

This dissertation is divided into two parts. In part 1, we have investigated whether we should monitor glucose in patients without diabetes, in order to diagnose ‘stress hyperglycaemia’. Two studies in this dissertation showed that it is not necessary to monitor glucose in patients undergoing ambulatory surgery and women undergoing a gynaecologic laparotomy, because stress hyperglycaemia was not associated with postoperative complications. Furthermore, a meta-analysis showed that a single administration of dexamethasone in the perioperative period does increase glucose values. However the existing studies so far do not indicate any increase in risk of postoperative infections due to dexamethasone or the transient increase in glucose.
In part two of this dissertation, we have investigated how we could optimise the perioperative treatment of patients with diabetes mellitus. Our studies showed that a pop-up in the electronic patient data system increased protocol compliance, a continuous glucose monitor could be of benefit, when one is aiming at strict glycaemic targets and treatment with liraglutide in the perioperative period could be of additional value. Our randomised trial showed that patients with diabetes type 2 treated with liraglutide had better glycaemic control and reduced insulin requirements compared to the groups with insulin boluses or an insulin infusion.