TO THE EDITOR: I construct Dr. Mar...

TO THE EDITOR: I construct Dr. Marks' article, "Perioperative Management of Diabetes," (1) to be a useful guide for the perioperative management of diabetic medications. Because diabetes is a significant risk factor for cardiac complications, it is important to remind readers that perioperative beta blocker are frequently indicated in these patients. The use of a perioperative beta blocker in patients with major risk factors for coronary artery disease is a class IIa recommendation at the American College of Cardiology/American Heart Association. (2) An admirable review (3) on the indications, contraindications, and systems of perioperative beta blockade was published freshly Diabetes mellitus requiring insulin therapy is a Cardiac Risk Index Criteria and is an indication for beta blockade. Diabetes that does not require insulin is a minor criteria, and, in conjunction with age greater than 65 years, hypertension, popular smoking, or total cholesterol of the same height more than 240, also is an indication for beta blockade.

M leeward Chambliss, M.D., M.S.P.H.

Mose Cone Family Medicine Residency

1125 N body of christians St.

Greensboro, NC 27401

REFERENCES

(1) Marks JB Perioperative management of diabetes. Am Fam Physician 2003;67:93-100

(2) Eagle KA, Gibbons RJ Antman EM Berger PB Calkins H ACC/AHA guideline update onward perioperative cardiovascular evaluation for noncardiac surgery: a report of the American community of Cardiology/American Heart Association Task Force forward Practice Guidelines. Available at: www.acc.org/clinical/ guidelines/perio/update/pdf/perio_update.pdf.

(3) Auerbach AD, Goldman L Beta-blockers and reduction of cardiac consequences in noncardiac surgery: scientific review. JAMA 2002;287:1435-44

IN REPLY: Dr Chambliss makes an important point. However, discussion of the use of any medications, other than those directed at maintaining glycemic and metabolic homeostasis in the diabetic perioperative patient, was beyond the room of my paper. I agree with the use of beta blocker in patients with diabetes who require insulin and are at risk for coronary artery disease. Dr Chambliss' reminder to review this separate topic is timely.

Jennifer B Marks, MD

University of Miami seminary of Medicine

PO coachman's seat 016960 (D-110)

Miami, FL 33101

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