Perioperative glucose management and the impact

The gap

Evidence profile

Sourced from the limitations and recommendations and synthesized of the source papers, classified as general, drawn from work published between 2023 and 2026, spanning 3 journals. Those papers have been cited 10 times in total.

Supporting evidence — 4 representative gaps

• Beyond HbA1c: Alternative Glycemic Biomarkers in Hemoglobinopathies, Malignancy, and Special Clinical Populations - A Review (2026) · International Journal of Drug Delivery Technology · doi

  (2) IJDDT, Volume 16 Issue 7s, 2026 304 Beyond HbA1c: Alternative Glycemic Biomarkers in Hemoglobinopathies, Malignancy, and Special Clinical Populations - A Review and studies; mechanistic incorporating (3) elucidating perioperative management; emerging evidence from continuous glucose monitoring validation the complex bidirectional relationships between hyperglycemia and cancer, pathways, epidemiological evidence, and implications for cancer screening (4) synthesizing recent advances in assay technology, standardization initiatives, and quality assurance programs; and (5) providing evidence-based clinical decision algorithms and practical implementation guidance for biomarker selection tailored to specific clinical scenarios. Through this integrative approach, we aim to equip clinicians with the knowledge and tools necessary to deliver precision glycemic assessment that transcends traditional HbA1c-centric paradigms and optimizes outcomes for patients with complex comorbidities.

  generallimitationsevidence 5/5
  Keywords: clinical evidence glycemic complex cancer ijddt volume issue beyond alternative biomarkers hemoglobinopathies malignancy special populations
• Evidence summary on perioperative blood glucose management in liver cancer patients (2026) · Frontiers in Oncology · doi

  level team-based perioperative glycemic management 1. Supported by a team of diabetes specialists, it helps standardize blood glucose monitoring and intervention (21). preoperative assessment management medication and nutritional management 2. Establish a multidisciplinary blood glucose management team led by hepatobiliary surgery, incorporating endocrinology, anesthesiology, nutrition, rehabilitation, and nursing teams, and provide specialized training for medical staff across relevant departments (21, 23, 26). 3. Utilizing an information-based blood glucose management system enables real-time monitoring, sharing, and automated alerts for perioperative blood glucose data (26). 4. Upon admission, liver cancer patients should undergo point-of-care testing (POCT), fasting blood glucose, and HbA1c assessments to evaluate baseline glycemic control and antidiabetic medication use. A comprehensive evaluation should include liver disease status, Child-Pugh classification, severity of hepatitis or cirrhosis, AFP levels, and endorgan damage (21). 5. Preoperative HbA1c testing is recommended to assess glycemic control over the past 3 months, supplemented by venous fasting blood glucose (FBG) and capillary blood glucose (CBG) to evaluate perioperative glucose levels. HbA1c ≥bA mmol/mol (6.5%) indicates diabetes, while HbA1c ≥bA mmol/mol (9.0%) suggests poor glycemic control. Elective surgery should be postponed to allow for glycemic optimization. Preoperative HbA1c should be optimized to <69 mmol/mol (8.5%) whenever possible. Values >69 mmol/mol (8.5%) warrant specialist consultation (16, 17) (21, 23, 24) 6. All diabetic patients should have a clear, written perioperative blood glucose management plan established prior to surgery, including fasting arrangements, adjustments to hypoglycemic medications, blood glucose monitoring frequency, and protocols for managing abnormal blood glucose levels (16). 7.Patients with perioperative hyperglycemia should receive the same level of perioperative blood glucose monitoring and management as those with known diabetes (16). 8. Adjust hypoglycemic therapy during the perioperative period based on drug type. All non-insulin hypoglycemic agents should be discontinued on the day of surgery. Among these, SGLT2 inhibitors should be stopped at least 2 days prior to surgery and on the day of surgery to reduce the risk of normal glycemic ketoacidosis. Continue basal insulin therapy perioperatively; avoid complete discontinuation of insulin. If patients are at risk for nocturnal or recent hypoglycemia, reduce basal insulin dosage by approximately 20% (16). 9. Variable Rate Intravenous Insulin Infusion (VRIII) is prioritized for: skipping >1 meal, T1DM without basal insulin, HbA1c >6.9% (8.5%), most emergency cases, and persistent perioperative hyperglycemia. The recommended fluid for the VRIII bypass is 5% glucose + 0.45% saline + KCl; alternating 5% glucose and 0.9% saline based on blood glucose levels is not recommended (17). 10. Intravenous administration of 2500 U/kg of ulinastatin prior to anesthesia induction and at the start of surgery in patients undergoing partial hepatectomy effectively prevents intraoperative insulin resistance (27). 11.For elderly patients undergoing liver resection, the intraoperative use of dexmedetomidine may help stabilize the stress response and thereby provide some assistance in controlling post-operative blood glucose levels (28). 12.The stress hyperglycemia ratio (SHR) can serve as an indicator for monitoring blood glucose levels in perioperative patients during nutritional support therapy (22). 13.For patients with perioperative hyperglycemia undergoing nutritional support, continuous insulin infusion via an intravenous infusion pump is an ideal strategy (19, 22). 14. For patients undergoing planned liver resection, minimize fasting duration by implementing a 6-hour preoperative fasting period and a 2-hour fluid restriction. Providing moderate carbohydrate beverages the night before surgery and 2 to 4 hours prior to anesthesia induction improves postoperative glucose control and significantly reduces perioperative insulin resistance compared to traditional overnight fasting (16– 20, 22, 25) blood glucose monitoring and targets 15.Appropriate blood glucose monitoring methods should be selected for different perioperative phases, with point-of-care testing (POCT) being the preferred choice, particularly for hemodynamically stable patients.

  generalrecommendationsevidence 5/5
  Keywords: glucose blood perioperative patients insulin monitoring surgery management glycemic fasting levels based preoperative liver control
• Evidence summary on perioperative blood glucose management in liver cancer patients (2026) · Frontiers in Oncology · doi

  level intensified during surgery and in the early postoperative period, and may be appropriately reduced once blood glucose levels stabilize (16, 21, 23). 16.During the perioperative period, ensure safe handover procedures between the operating room, anesthesia recovery room, and patient ward. Maintain complete documentation of blood glucose monitoring results, medication administration, and relevant medical orders (21). 17. Develop personalized blood glucose monitoring protocols. Blood glucose monitoring is performed upon patient admission, on the morning of surgery, during surgery, and upon return to the ward postoperatively. For patients with abnormal blood glucose levels, monitoring is conducted every 30–60 minutes during surgery and every 1–2 hours postoperatively. In cases of abnormal blood glucose fluctuations, monitoring frequency should be increased as necessary based on blood glucose levels, or CGM should be employed. This should be combined with blood gas analysis to ensure effective management of blood glucose, electrolytes, and acid-base balance (18, 21, 22, 26) 18. Intraoperative blood glucose targets should be maintained between 6.0–10.0 mmol/ L, with routine point-of-care testing (POCT) monitoring every 2 hours (17, 21, 24). 19. Minimize blood glucose fluctuations in patients with perioperative stress hyperglycemia (SH) during nutritional support therapy, maintaining blood glucose levels between 8.0–10.0 mmol/L (22). 20. The target blood glucose level within 3 days postoperatively should be <12.0 mmol/ L (21). 21.Definition of hypoglycemia: CBG <4 mmol/L; For individuals with lower hypoglycemia risk managed by diet and medication: Recommended target range is 4–12 mmol/L; For most patients using hypoglycemic agents/insulin: Intervention should be considered at CBG <6.0 mmol/L to prevent hypoglycemia (16, 17). 22. Hypoglycemia is a significant perioperative risk. When hypoglycemia is suspected during the perioperative period, point-of-care testing (POCT) should be performed immediately and reported to the physician. For patients with confirmed hypoglycemia, monitoring intervals should be shortened based on clinical condition until blood glucose is corrected (21, 24). 23. Intervention should be considered when blood glucose exceeds 10 mmol/L. Discontinue VRIII and treat hypoglycemia when glucose falls below 6 mmol/L, then restart within 20 minutes. If glucose remains above 12 mmol/L for three consecutive readings with insufficient decline, increase the infusion rate. Reduce the VRIII rate if hypoglycemia risk factors are present (16, 17). 24. When hypoglycemia is confirmed by a conscious individual, immediately administer 15 g of carbohydrates. Perform a point-of-care test (POCT) after 15 minutes. If blood glucose remains uncorrected, repeat the above measures. If blood glucose has been corrected to 3.9 mmol/L or above but the next meal is more than 1 hour away, continue providing starchy or protein-containing foods (21). 25.If the patient experiences discomfort or persistent hyperglycemia (>13 mmol/L on two or more consecutive occasions), measure capillary blood ketones. For patients regularly using SGLT2 inhibitors, daily blood ketone monitoring is recommended during hospitalization (17). 26.When blood glucose exceeds 13.9 mmol/L or symptoms such as nausea and vomiting occur, immediately notify the physician for intervention and perform POCT testing once every 30 minutes (21). 27.For patients with primary liver cancer and diabetes undergoing surgery, implementing glycemic index (GI)-based dietary guidance in addition to conventional dietary advice improves glucose metabolism control during the 1–3 months postsurgery (29). 28. Diabetes education for patients and their families is provided throughout the perioperative period (23).

  generalrecommendationsevidence 5/5
  Keywords: blood glucose mmol hypoglycemia monitoring patients surgery perioperative period levels every minutes poct patient postoperatively
• Diabetesmanagement im Krankenhaus (Update 2023) (2023) · Wiener klinische Wochenschrift · cited 10× · doi

  Perioperative glucose management and the impact of surgical stress on glycemic control in diabetic patients is mentioned in one position statement but not empirically evaluated; none of these papers provide data on perioperative outcomes, optimal glucose targets during surgery, or the effectiveness of specific insulin protocols in the operating room or immediate postoperative period for hospitalized diabetic patients.

  generalsynthesizedevidence 5/5
  Keywords: perioperative glucose management impact surgical stress glycemic control

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