菜单
If achieving preoperative HbA1c <8% is not feasible, target preoperative blood glucose concentrations of 100 to 180 mg/dL instead. Trigger phrase: "Cannot meet HbA1c goal, what glucose target should we use preoperatively?"
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基于 SOC 职业分类
| name | es-preop-bg-only-target |
| description | If achieving preoperative HbA1c <8% is not feasible, target preoperative blood glucose concentrations of 100 to 180 mg/dL instead. Trigger phrase: "Cannot meet HbA1c goal, what glucose target should we use preoperatively?" |
Collect the patient's most recent HbA1c, assess feasibility of achieving <8% preoperatively (consider time until surgery, resources, and patient factors), and obtain a current point-of-care blood glucose (POC-BG) measurement.
Is achieving preoperative HbA1c <8% feasible? If yes, target HbA1c <8% and BG 100–180 mg/dL per Recommendation 5.1. If not feasible, proceed to Step 3.
Classify the preoperative POC-BG: if 100–180 mg/dL, continue current regimen; if <100 mg/dL, evaluate for hypoglycemia risk; if >180 mg/dL, initiate corrective insulin to bring glucose into target range.
Adjust diabetes management (e.g., insulin dosing, noninsulin agents) to maintain preoperative BG within 100–180 mg/dL, rechecking POC-BG 1–4 hours before surgery; if persistently outside range, consider adding scheduled insulin therapy.
Do not rely solely on HbA1c when conditions affecting its accuracy are present (anemia, hemoglobinopathies, chronic renal failure, alcoholism, drugs, large BG variations); avoid preoperative caloric carbohydrate-containing oral fluids; do not use sliding scale insulin alone for persistent hyperglycemia ≥180 mg/dL; ensure BG measured 1–4 hours preoperatively.
A patient with type 2 diabetes scheduled for elective hip replacement in 2 days has HbA1c 8.5% and cannot realistically achieve <8% preoperatively. POC-BG measured 2 hours before surgery is 165 mg/dL (within target); proceed with surgery. If POC-BG were 210 mg/dL, administer 4 units rapid-acting insulin and recheck in 1 hour.
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 es-preop-bg-only-target calculator
