Diabetes Mellitus comes with a host of risk factors that make caring for them during surgery a challenge. Hypergly-
cemia is the most important modifiable risk factor because it can cause infections and delay wound healing. With the
ever-growing list of medications used to control diabetes, it becomes unclear which medications are the safest and
most useful at improving perioperative outcomes. This literature review aims to highlight current treatment proto-
cols and possible improvements in patient care. Search terms like “glycemic control” and “perioperative care” were
used in OpenEvidence, PubMed, and Google Scholar to find relevant research articles. Currently, the standard of
care for diabetic patients involves stopping most of their medications the day before surgery so that the anesthesiol-
ogist can have better glycemic control. For cardiac surgeries, insulin glargine and magnesium sulfate have shown to
be very useful at lowering blood sugars without causing hypoglycemia, whereas GLP-1 agonists and GIK infusions
perform similarly in non-cardiac surgery. Treatment methods such as sliding scale insulin regimens, metformin,
or carbohydrate loading before surgery cause more perioperative complications and aren’t recommended. Data on
other anti-diabetes medications, like thiazolidinediones, insulin secretagogues, and SGLT-2 inhibitors, are lacking
due to the current standard of care not using these medications perioperatively. Further research is needed on the
effectiveness of insulin treatment strategies due to how most of the medication being studied are mainly useful in
type 2 diabetes instead of type 1. Newer insulins like intranasal insulin also need more research to determine their
usefulness.
