Diabetes and postoperative cognitive dysfunction and delirium in adults: mechanisms, biomarkers, and clinical management

Postoperative cognitive dysfunction (POCD) and postoperative delirium (POD) are common perioperative neurocognitive disorders, particularly affecting individuals with diabetes, who show a disproportionately higher susceptibility. Diabetic patients are at higher risk due to blood sugar fluctuations, vascular changes, and inflammation that can affect brain function. This review explores how diabetes contributes to POCD and POD, the role of biomarkers in identifying those at risk, and strategies to prevent and manage these complications. A thorough analysis of current studies highlights that factors such as hyperglycemia, glycemic variability, and diabetes-related complications significantly increase the likelihood of cognitive problems after surgery. While several tools exist to assess cognition and delirium, none reliably detect early changes on their own, underscoring the need for integrated approaches that combine biomarkers and clinical assessment. Interventions like tight blood sugar control, careful perioperative monitoring, and cognitive rehabilitation may help reduce these risks. Overall, understanding the link between diabetes and postoperative cognitive complications and implementing personalized care plans are key to improving recovery and quality of life for diabetic patients. Future research should prioritize the standardization of diagnostic criteria, the clinical validation of perioperative biomarkers, and the development of targeted preventive and therapeutic strategies for patients at increased perioperative neurocognitive risk.