Zusammenfassung
Für die perioperative Phase besteht bei Patienten mit Diabetes mellitus ein erhöhtes
Risiko für Komplikationen, z. B. durch Entgleisung des Glukosestoffwechsels, erhöhte
Rate kardiovaskulärer Ereignisse, Verschlechterung einer vorbestehenden Niereninsuffizienz
und vermehrt auftretende Wundinfektionen. Zudem können Nebenwirkungen der antidiabetischen
Therapie auftreten. Ein spezieller Umgang mit der Dauermedikation bei solchen Patienten
ist wichtig.
Abstract
Drug therapy, as well as diabetes technology, e.g. insulin pumps or sensor glucose
measurement, have developed enormously in recent years. Their use differs according
to the type of diabetes, secondary or concomitant diseases, and individual factors
and target values. In the perioperative phase, diabetic patients are generally at
increased risk of complications, including a derailment of glucose metabolism, an
increased rate of cardiovascular events, worsening of preexisting renal insufficiency,
and increased incidence of wound infections. In addition, drug class-specific side
effects of antidiabetic therapy may occur. The prevalence of diabetes patients in
anesthesiology is high and will continue to increase. In Germany, more than 8 million
people are estimated to live with diabetes mellitus. The rate of new cases is about
600 000 per year. The distinction between type 1 and type 2 diabetes mellitus is essential.
Diabetes therapy is becoming increasingly individualized;
combination therapies are becoming more common. Therefore, the management of
long-term medication should also be individualized. Substance-specific side effects
or adverse effects, especially of oral antidiabetic agents, must be considered in
the care of patients, e.g. euglycemic diabetic ketoacidosis under SGLT-2 inhibitors
is a relevant problem. Insulin therapy is also evolving; knowledge of new preparations
and of insulin pump therapy facilitates perioperative management. Both hypoglycemia
and hyperglycemia, possibly with ketoacidosis, must be avoided. The purpose of this
article is to provide an overview of the management of long-term medication in patients
with diabetes mellitus.
Schlüsselwörter
perioperatives Management - Diabetes mellitus - Insulin - orale Antidiabetika - Glukosekontrolle
Key words
perioperative management - diabetes mellitus - insulin - oral antidiabetic drugs -
glucose control
