Perioperative diabetes management in major surgery: A narrative review
DOI:
https://doi.org/10.62827/fb.v27i9.1352Keywords:
Hyperglycemia; Insulin; Postoperative Complications; Patient Safety.Abstract
Diabetes and stress hyperglycemia are associated with infection, metabolic instability, and longer hospital stay after major surgery. This narrative review compared recent recommendations from consensus statements, position statements, and guidelines on preoperative assessment, adjustment of antidiabetic drugs, and glucose targets, examined in light of systematic reviews and observational studies. PubMed was searched on September 29, 2026, with two strategies restricted to publications from 2020 to 2026; of the 27 records retrieved, 10 were included, and three complementary sources were added. The documents agree on an upper glucose limit of 180 mg/dL, on maintaining basal insulin at a reduced dose, and on ketone monitoring in users of sodium-glucose cotransporter 2 inhibitors. They diverge on postponing surgery because of elevated glycated hemoglobin, on the withholding interval for these inhibitors, which ranges from omission on the day before and the day of surgery to three or four days, and on withholding glucagon-like peptide 1 receptor agonists in patients at higher risk of aspiration. Divergences concentrate where the evidence is weakest, and most recommendations derive from expert consensus and observational studies. Services should build institutional protocols from a critical appraisal of these sources and of their local applicability, with periodic updating.
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Copyright (c) 2026 Luiza Rocha Pinto Coelho, Maria Vitória Feitosa Carvalho, Carlos Henrique Barros de Souza , Gabriel Maia Nascimento , Lucas Wendell da Cruz (Autor)
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