菜单
Recommends targeting preoperative HbA1c <8% and blood glucose 100–180 mg/dL in adults with diabetes undergoing elective surgery. Use when scheduling elective surgery in a diabetic patient or reviewing HbA1c or point-of-care glucose.
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| name | endo-preoperative-hba1c-bg-target-elective-surgery |
| description | Recommends targeting preoperative HbA1c <8% and blood glucose 100–180 mg/dL in adults with diabetes undergoing elective surgery. Use when scheduling elective surgery in a diabetic patient or reviewing HbA1c or point-of-care glucose. |
Confirm diabetes diagnosis, elective surgery schedule, obtain most recent HbA1c and point-of-care glucose; assess conditions that may affect HbA1c reliability (anemia, hemoglobinopathies, chronic renal failure, alcoholism, drugs, large glucose variability).
Is it reasonable to allow time for interventions targeting HbA1c <8%? If yes, proceed to HbA1c optimization pathway; if no, proceed to blood glucose target pathway.
If HbA1c pathway: classify HbA1c as <8% (target met) or ≥8% (needs intervention). If BG pathway: classify recent glucose as within 100–180 mg/dL (target met) or outside this range (needs intervention).
If target met, proceed with routine preoperative care; if not met, intensify glucose-lowering therapy (e.g., adjust metformin, initiate insulin) and recheck HbA1c or glucose in 1–2 weeks.
Do not rely on HbA1c if conditions affecting erythrocyte turnover (anemia, hemoglobinopathies, renal failure) are present; avoid delaying urgent surgery for HbA1c optimization; do not administer preoperative caloric carbohydrate-containing fluids; avoid sliding scale insulin alone for persistent hyperglycemia ≥180 mg/dL.
A 60‑year‑old with type 2 diabetes scheduled for elective knee arthroplasty in 3 weeks has HbA1c 8.4% and fasting glucose 135 mg/dL. Since time permits, aim for HbA1c <8% via metformin uptitration; after 3 weeks HbA1c 7.7% and glucose 120 mg/dL, proceed to surgery.
Source: Management of Hyperglycemia in Hospitalized Adult Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2022, https://doi.org/10.1210/clinem/dgac278
TODO: consider adding scripts/calc.py for the endo-preoperative-hba1c-bg-target-elective-surgery calculator