A practical approach to managing diabetes in the perioperative period

Diabetes mellitus (DM) is a common multisystem disease with hyperglycaemia as the hallmark. It is a modifiable risk factor of complications after surgery. The incidence of DM and its impact on public health are steadily increasing globally. In South Africa (SA), it is estimated that a large proportion of people living with DM are undiagnosed. A number of international groups have addressed the problem of DM in the perioperative period, proposing guidelines for optimisation and management of these patients. The guidelines fail to address the variety of contexts within which surgery is delivered in SA. In this review, the authors discuss DM within the SA context. The article provides a range of approaches to managing the patient with DM in the perioperative period. Importantly, the perioperative healthcare provider’s approach should be steered by a local multidisciplinary team that considers the evidence base in light of their resource and patient context.