Interdisciplinary Strategies for Perioperative Glycemic Optimization in Diabetic Patients: A Narrative Review

Abstract

Diabetes mellitus is one of the most common and important comorbidities in surgical patients, with an estimated 537 million people globally and 15-20% of all surgeries. In addition to patients with a known diagnosis, perioperative hyperglycemia occurs in up to 40% of non-cardiac surgical patients, including a significant proportion with undiagnosed prediabetes or stress-induced dysglycemia. The stress response to surgery, via activation of the hypothalamic-pituitary-adrenal axis and sympathetic nervous system, results in a release of counter-regulatory hormones that induce hepatic gluconeogenesis, peripheral insulin resistance, and systemic inflammation, all of which contribute to impaired glucose metabolism during the entire perioperative period. These derangements are independently linked to surgical site infections, wound healing complications, acute kidney injury, cardiovascular instability, extended hospital stays, and death. This narrative review examines the evidence from clinical trials, cohort studies, and practice guidelines published from 2016 to 2026 to assess the current multidisciplinary strategies for perioperative glucose management in adult surgical patients with diabetes. The review explores the pathophysiology of perioperative hyperglycemia, reviews preoperative risk stratification approaches including the use of glycated hemoglobin, reviews intraoperative glucose monitoring and insulin administration protocols, and reviews postoperative management strategies including basal-bolus-correction insulin protocols and discharge planning. The literature supports a glucose target of 140-180 mg/dL as a reasonable compromise between avoiding the adverse effects of hyperglycemia and the risks of iatrogenic hypoglycemia. The review concludes that better perioperative outcomes are not achieved through new interventions, but rather through the consistent application of current evidence through protocol-based management and interdisciplinary collaboration between surgical, anesthetic, medical, nursing and pharmacy teams. Knowledge gaps exist in the area of individualised glucose targets, perioperative management of newer antidiabetic medications, the accuracy of continuous glucose monitoring in the dynamic intraoperative setting, and the wider adoption of interdisciplinary care models in different health care settings.