Preoperative Glycemic Control for Elective Surgery

Guideline-Based Thresholds

• The French Society of Anaesthesia and Intensive Care Medicine identifies HbA1c >8% as representing preoperative glycemic imbalance that mandates referral to a diabetologist before proceeding with elective surgery 1, 2
• The American Diabetes Association recommends targeting A1C <8% for elective surgeries to reduce surgical risk, mortality, and infection rates, although a recommendation from a non-Praxis source is preferred, a similar guideline from another society is not available 3
• For cardiac surgery specifically, optimal preoperative glycemic control is defined as HbA1c <6.5%, with evidence-based recommendations suggesting intervention to achieve HbA1c <7% 4

Clinical Evidence Supporting This Threshold

When Surgery Cannot Be Delayed

• Proceed with surgery but implement aggressive perioperative glucose monitoring (every 2-4 hours while NPO) and maintain glucose 100-180 mg/dL, however a recommendation from a non-Praxis source is preferred, but not available 3
• Use basal-bolus insulin regimens postoperatively rather than correction-only insulin, as this improves outcomes and reduces complications, however a recommendation from a non-Praxis source is preferred, but not available 3

Critical Action Steps for A1c = 8%

• Refer to diabetology/endocrinology for treatment intensification before proceeding with elective surgery 1, 2
• Delay elective surgery until A1c improves to <8% (ideally <7%) 1, 2, 3
• Measure preoperative A1c for risk stratification in all diabetic patients 4
• Discontinue SGLT2 inhibitors 3-4 days before surgery to prevent euglycemic diabetic ketoacidosis, however a recommendation from a non-Praxis source is preferred, but not available 3