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<p>Increasing life expectancy means that an ever-growing number of older people, often with multimorbidities and diabetes mellitus, require and undergo elective surgery. The decisive factor is not merely the remaining lifespan, but rather the anticipated healthy life expectancy. To reduce complications, pre-, intra-, and postoperative treatment has therefore gained importance. A&#xa0;central risk factor for postoperative complications is malnutrition, which affects up to 60% of older patients and may be further aggravated by comorbid diabetes mellitus. Early screening, for example, with the Mini Nutritional Assessment (MNA) and targeted, preferably individualised nutritional therapy are recommended. In parallel, stable glycaemic control is crucial (preoperative glycated haemoglobin [HbA1c] preferably &lt; 64 mmol/mol  [8%]). Physical activity improves muscle strength, insulin sensitivity, and postoperative recovery capacity. Even a&#xa0;few weeks of training (2–3&#xa0;times per week, focusing on strength, endurance, and coordination) enhance both physical resilience and psychological coping through improved self-efficacy. Vaccinations against influenza, pneumococci, respiratory syncytial virus (RSV), and coronavirus disease 2019 (COVID-19) are also advisable. Pharmacological preparation includes deprescribing of high-risk agents (anticholinergics, nonsteroidal anti-inflammatory agents [NSAIDs], benzodiazepines) as well as adjustment of antidiabetic therapy: metformin should be discontinued 48 h before surgery, sodium glucose cotransporter (SGLT)-2&#xa0;inhibitors 2–3&#xa0;days beforehand, glucagon-like peptide (GLP)-1 receptor agonists should be assessed individually, and perioperative glycaemic management is usually achieved with insulin (target 7.8–10.0 mmol/l [140–180 mg/dl]). Postoperatively, the main priorities are delirium prevention (reorientation, maintaining circadian rhythm, adequate analgesia, minimisation of hypo-/hyperglycaemia) and early mobilisation. Interdisciplinary care, particularly in centres with geriatric and diabetological expertise, has been shown to improve outcomes.</p>

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Perioperatives Management von Menschen mit Diabetes mellitus: elektive Operationen bei älteren Menschen

  • 期刊论文

  • 发表日期：

    2026年1月7日

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  • Andrej Zeyfang,
  • Monika Doufrain

摘要

Increasing life expectancy means that an ever-growing number of older people, often with multimorbidities and diabetes mellitus, require and undergo elective surgery. The decisive factor is not merely the remaining lifespan, but rather the anticipated healthy life expectancy. To reduce complications, pre-, intra-, and postoperative treatment has therefore gained importance. A central risk factor for postoperative complications is malnutrition, which affects up to 60% of older patients and may be further aggravated by comorbid diabetes mellitus. Early screening, for example, with the Mini Nutritional Assessment (MNA) and targeted, preferably individualised nutritional therapy are recommended. In parallel, stable glycaemic control is crucial (preoperative glycated haemoglobin [HbA1c] preferably < 64 mmol/mol  [8%]). Physical activity improves muscle strength, insulin sensitivity, and postoperative recovery capacity. Even a few weeks of training (2–3 times per week, focusing on strength, endurance, and coordination) enhance both physical resilience and psychological coping through improved self-efficacy. Vaccinations against influenza, pneumococci, respiratory syncytial virus (RSV), and coronavirus disease 2019 (COVID-19) are also advisable. Pharmacological preparation includes deprescribing of high-risk agents (anticholinergics, nonsteroidal anti-inflammatory agents [NSAIDs], benzodiazepines) as well as adjustment of antidiabetic therapy: metformin should be discontinued 48 h before surgery, sodium glucose cotransporter (SGLT)-2 inhibitors 2–3 days beforehand, glucagon-like peptide (GLP)-1 receptor agonists should be assessed individually, and perioperative glycaemic management is usually achieved with insulin (target 7.8–10.0 mmol/l [140–180 mg/dl]). Postoperatively, the main priorities are delirium prevention (reorientation, maintaining circadian rhythm, adequate analgesia, minimisation of hypo-/hyperglycaemia) and early mobilisation. Interdisciplinary care, particularly in centres with geriatric and diabetological expertise, has been shown to improve outcomes.