Perioperative Management of Diabetic Medications in Patients Undergoing Elective Total Joint Arthroplasty: A Review of Current Guidelines and Recommendations.

Abstract

The prevalence of diabetes in patients undergoing total joint arthroplasty (TJA) is steadily increasing. Diabetes predisposes patients to major complications such as prosthetic joint infection (PJI), which poses major challenges to the patient and surgeon. Therefore, careful perioperative glucose management in these patients is critical. Medications have been the mainstay in the management of diabetes; however, these medications are each associated with their unique risk profile in the perioperative period. This review evaluated the available literature regarding the 10 main diabetic medication classes, their mechanism of action, adverse effects, and current perioperative management recommendations. Available literature addressing perioperative diabetic medication management in TJA is still lacking; however, there are still many guidelines that have been synthesized for these medications in both an elective surgery setting and within TJA. Based on this literature review, we provided a summation of the perioperative guidelines for the ten main diabetic drug classes and what the current available perioperative guidelines are. Many of these medication classes have not been studied yet in the setting of TJA. However, we hope this summation offers orthopaedic providers a practical clinical guideline and insight into managing and treating their diabetic patients preoperatively.