Stress hyperglycemia and treatment in perioperative care

Delayed wound healing, increased risk of surgical site infections, and other complications following surgical procedures have a widely documented link to diabetes due to insulin resistance inherent to the disease. Variations in perioperative glucose control not only affect patients with diabetes but may also contribute to even more significant risks in patients without diabetes due to perioperative stress hyperglycemia. Perioperative stress hyperglycemia can occur due to the body's physiological stress responses to the surgical procedure, perioperative medications, discontinuation of diabetes-related medication, or a combination of factors. Hospital-based hyperglycemia protocols are often structured only around diabetes; however, increasing evidence supports glucose monitoring protocols for patients without diabetes to ensure improved perioperative glucose control. Incorporating the standard practice of preoperative hemoglobin A1C (HgbA1C) testing gives the clinician perspective on issues of glucose and insulin metabolism before the surgical procedure. The HgbA1C helps determine safe and effective insulin doses for the perioperative treatment of hyperglycemia. By incorporating safe and effective perioperative glucose monitoring and insulin treatment protocols, the health care system can proactively reduce postoperative complications due to unrecognized and untreated hyperglycemia.