to the editor: I found 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 blockers are often 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 by the American College of Cardiology/American Heart Association.² An excellent review³ on the indications, contraindications, and methods of perioperative beta blockade was published recently. 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, current smoking, or total cholesterol level more than 240, also is an indication for beta blockade.

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 scope of my paper. I agree with the use of beta blockers 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.