Heart transplant (HT) is the gold standard treatment for people with end stage heart failure (HF). Up to 46 % of patients with chronic HF are malnourished and increasing rates of obesity have also been identified. Therefore, at time of HT assessment, patients are required to meet eligibility criteria, including nutrition targets. It is recommended that patients being considered for HT receive comprehensive assessment by a multidisciplinary team (MDT) to assist in meeting HT criteria. This study aimed to describe the baseline nutritional characteristics of patients undergoing HT assessment and to explore the impact of dietetic intervention on key nutritional parameters including BMI and malnutrition status pre-transplant.

This study was a single-centre combined retrospective and prospective observational cohort study. Adults who underwent HT assessment and met inclusion criteria between January 1, 2015 and June 30, 2021 were included. Key nutrition-related parameters assessed were weight, Body Mass Index (BMI), and nutritional status using the Subjective Global Assessment (SGA): A well-nourished, B and C moderately and severely malnourished, collected at HT assessment, listing and HT. The impact of dietetic intervention on nutrition-related parameters was also assessed.

255 patients were included, with 2.7 % (n = 7) underweight, 32.2 % healthy weight, 38.8 % overweight and 26.3 % obese. Of 161 patients assessed using the SGA 22.4 % (n = 36) were moderately or severely malnourished. 26 patients had a relative nutrition contraindication for HT listing (BMI>35 kg/m2 and/or HbA1c >7.5 %) and n = 39 had suboptimal nutritional status including BMI <18.5 kg/m2 and/or presence of malnutrition.Dietetic intervention did not result in statistically significant changes in weight, BMI or nutritional status. 25.5 % of patients had relative nutritional contraindications to HT or suboptimal nutritional parameters and 9 had a decline in nutritional status, defined as developing malnutrition or worsened malnutrition.

This study showed a quarter of HT patients had suboptimal nutrition-related parameters including malnutrition, underweight, overweight or obesity at time of HT assessment, indicating opportunity for improved nutrition support prior to HT. The results also indicated that nutritional status can deteriorate in patients waiting for HT. Routine nutrition assessment and regular monitoring by a dietitian has the potential to support patients in their HT journey through optimising BMI and preventing nutritional decline.

Patients with impaired glucose metabolism have an increased incidence of post-operative complications. The best marker for glycemic control prior to elective orthopedic surgery remains unclear. We aimed to assess the utility of the hemoglobin glycation index (HGI) in predicting early complications following elective orthopedic surgery.

We retrospectively enrolled 1496 patients who underwent elective orthopedic surgery at Fujian Provincial Hospital in China from Jan 2015 to Jan 2023. Restricted cubic spline (RCS) was used to select the cutoff value of HGI. Propensity score matching (PSM) was performed to reduce confounding bias, and multivariate logistic regression models (with and without adjustment) for complication outcomes were applied to evaluate the odds ratios of HGI.

The U-shaped curve in RCS analysis suggested dividing HGI into three subgroups: the reference interval (-0.76 to -0.10), the lower group (≤ -0.76), and the higher group (> -0.10). The incidence of early complications significantly increased from the lower (12.5%) and higher (12.2%) subgroups to the reference interval (6.9%). Following PSM, total postoperative complications were more common in patients with lower HGI (OR: 3.272, 95% CI: 1.417-7.556), but patients in the higher HGI subgroup had a higher risk of incision complications (OR: 3.735, 95% CI: 1.295-10.769).

After adjusting for HbA1c levels, higher HGI (> -0.1) was a risk factor for incision complications, but not for other complications. The risk of overall postoperative complications in patients with lower HGIs (≤ -0.76) should not be ignored.

Maintaining optimal glucose control is critical for postoperative care cardiac surgery patients. Continuous glucose monitoring (CGM) in this setting remains understudied. We evaluated the efficacy of CGM with a specialized titration protocol in cardiac surgery patients with type 2 diabetes (T2D) and prediabetes.

In this randomized-controlled trial, 54 cardiac surgery patients were randomized one day post-surgery, with 27 CGM and 25 point-of-care (POC) patients completing the study. The CGM group used Dexcom G6 with a CGM-specialized titration protocol, while the POC group used standard monitoring with blinded CGM. The primary outcome was time-in-range (TIR) 100-180 mg/dL for 7 days post-surgery. Secondary outcomes included various glycemic metrics and surgical outcomes. Multiple comparison adjustments were performed using false-discovery-rate (FDR).

Thirty-one (59.6%) had diabetes and 21 (40.4%) had prediabetes. While TIR 100-180 mg/dL showed no difference (74.7% vs. 71.6%, FDR-adjusted p = 0.376), the CGM group demonstrated improvements in TIR 70-180 mg/dL (83.8% vs. 75.8%, FDR-adjusted p = 0.026), time-in-tight-range (TITR) 100-140 mg/dL (46.3% vs. 36.3%, FDR-adjusted p = 0.018), and TITR 70-140 mg/dL (55.3% vs. 40.5%, FDR-adjusted p = 0.003). Both groups maintained very low rates of time below range (< 70 mg/dL: 0.03% vs. 0.18%, FDR-adjusted p = 0.109). The CGM group showed lower postoperative atrial fibrillation (AF) (18.8% vs. 55.6%, FDR-adjusted p = 0.04999).

While the primary outcome was not achieved, CGM with a specialized titration protocol demonstrated safe glycemic control with improvements in TIR 70-180 mg/dL and TITRs in cardiac surgery patients with T2D and prediabetes. The observed reduction in postoperative AF warrants further investigation.

ClinicalTrials.gov NCT06275971.

To assess the efficacy and safety of fully closed-loop (FCL) compared with usual care (UC) glucose control in patients experiencing major abdominal surgery-related stress hyperglycemia.

Major abdominal surgery-related stress and periprocedural interventions predispose to perioperative hyperglycemia, both in diabetes and non-diabetes patients. Insulin corrects hyperglycemia effectively, but its safe use remains challenging.

In this two-centre randomized controlled trial, we contrasted subcutaneous FCL with UC glucose management in patients undergoing major abdominal surgery anticipated to experience prolonged hyperglycemia. FCL (CamAPS HX, Dexcom G6, mylife YpsoPump 1.5x) or UC treatment was used from hospital admission to discharge (max 20 d). Glucose control was assessed using continuous glucose monitoring (masked in the UC group). The primary outcome was the proportion of time with sensor glucose values in a target range of 5.6 to 10.0 mmol/L.

Thirty-seven surgical patients (54% pancreas, 22% liver, 19% upper gastrointestinal, 5% lower gastrointestinal), of whom 18 received FCL and 19 UC glucose management, were included in the analysis. The mean ± SD percentage time with sensor glucose in the target range was 80.1% ± 10.0% in the FCL and 53.7% ± 19.7% in the UC group ( P < 0.001). Mean glucose was 7.5 ± 0.5 mmol/L in the FCL and 9.1 ± 2.4 mmol/L in the UC group ( P = 0.015). Time in hypoglycemia (<3.0 mmol/L) was low in either group. No study-related serious adverse events occurred.

The FCL approach resulted in significantly better glycemic control compared with UC management, without increasing the risk of hypoglycemia. Automated glucose-responsive insulin delivery is a safe and effective strategy to minimize hyperglycemia in complex surgical populations.

Patients with diabetes are considered to be at high surgical risk due to the potential occurrence of cardiovascular and diabetes-related complications. Limited research exists on the cardiovascular risk profiles of patients with prediabetes and undiagnosed diabetes in noncardiac surgery. In this population-based cohort study, we investigated different glycated hemoglobin levels and their associated postoperative cardiovascular risks.

In this perioperative cohort study, participants were categorized into four groups: nondiabetes, prediabetes, undiagnosed diabetes, and diagnosed diabetes. The primary endpoint was the occurrence of major adverse cardiovascular events (MACE) at 30 days postoperatively, with secondary outcomes assessed at 90 days. The association between various groups and postoperative MACE was evaluated using Cox proportional hazards models and Kaplan-Meier curves. Subgroup analyses and sensitivity analyses were also performed.

We enrolled 13 207 eligible patients undergoing noncardiac surgeries, among whom 3841 (29.08%) had prediabetes and 1521 (11.52%) had undiagnosed diabetes. In the 30-day postoperative period, the prediabetes group (hazard ratio [HR] [95% CI]: 1.70 [1.15, 2.52]), undiagnosed diabetes group (HR [95% CI]: 2.36 [1.15, 3.68]), and diagnosed diabetes group (HR [95% CI]: 2.33 [1.54, 3.53]) exhibited increased risks of MACE compared to the nondiabetes group. Similar findings were observed for the 90-day postoperative MACE. Further subgroup analysis revealed a significant interaction between sex and states of glycemic regulation (P for interaction < 0.005).

In this cohort, a notable proportion of patients with prediabetes or undiagnosed diabetes were found to be undergoing noncardiac surgeries. They were associated with an increased risk of developing postoperative MACE.

Perioperative management in diabetic patients is important since their postoperative mortality and morbidity are higher than that of non-diabetic patients, which will exacerbate the burden on public health. We selected relevant publications from the WoSCC-SCIE between 2007 and 2024, utilizing VOSviewer and CiteSpace to analyze the collected information and generate knowledge maps. A total of 3167 articles from 792 journals and 83 countries/regions were included for analysis. Overall, there has been a continuous increase in publication volume. From the result of academic collaboration between different countries/regions and institutions, the USA occupies a central position in research strength. A total of 18,101 authors participated in research on "perioperative management in diabetic patients" with Dr. Guillermo E. Umpierrez from Emory University School of Medicine being the most productive author. We conclude that perioperative adverse clinical outcomes in diabetic patients and perioperative blood glucose management have consistently been research hotspots in this field. Additionally, continuous glucose monitoring and insulin administration under computer guidance, as well as the use of merging medications are likely to be frontier directions for future research. Research on perioperative care for diabetic patients has been further deepened worldwide, which will be crucial in further improving perioperative care for diabetic patients and enhancing postoperative recovery.

Type 2 diabetes mellitus affects over 500 million people globally, with 10%-20% requiring surgery. Patients with diabetes are at increased risk for perioperative complications, including prolonged hospital stays and higher mortality, primarily due to perioperative hyperglycemia. Managing blood glucose during the perioperative period is challenging, and conventional monitoring is often inadequate to detect rapid fluctuations. Clinical decision support systems (CDSS) are emerging tools to improve perioperative diabetes management by providing real-time glucose data and medication recommendations. This viewpoint examines the role of CDSS in perioperative diabetes care, highlighting their benefits and limitations. CDSS can help manage blood glucose more effectively, preventing both hyperglycemia and hypoglycemia. However, technical and integration challenges, along with clinician acceptance, remain significant barriers.

Patients with poor perioperative glycaemic control after total joint arthroplasty are at an increased risk of complications, mortality, delayed return to function and increased costs of care. Although correction of hyperglycaemia has been shown to improve patient outcomes, there is a lack of consensus regarding optimal perioperative glucose management after total joint replacement surgery. This pilot study aims to assess the feasibility of performing a multicentre randomised controlled trial to investigate the effect of perioperative metformin use on glycaemic control in the setting of total joint arthroplasty.

This blinded, placebo-controlled, pilot randomised controlled trial will enrol 40 participants aged 18-99 years undergoing total hip or knee arthroplasty at a single academic tertiary centre. Patients will be randomly allocated to two groups of 20 participants each and will receive metformin or a placebo, respectively, for 2 weeks preoperatively, continued on the day of surgery, and up to 2 days postoperatively. The primary outcome is a composite of four endpoints to assess study feasibility: timely recruitment, timely study drug administration, protocol adherence and retention. Secondary outcomes include perioperative glycaemic variability, sliding scale insulin utilisation, hospital length of stay and 90-day rates of infection, mortality and readmission. Analyses will be on an intention-to-treat basis.

The protocol was approved by Oregon Health & Science University Institutional Review Board, STUDY00025798. Written informed consent will be obtained for study participation. Findings will be disseminated via publication in peer-reviewed journals and conference presentations.

NCT06280274.

Case reports of postoperative diabetic ketoacidosis in patients using sodium-glucose cotransporter 2 inhibitor (SGLT2i) medications underlie guidance by the US Food and Drug Administration to withhold SGLT2i medication for at least 3 days prior to surgery. Given the potential negative consequences associated with preoperative medication withholding, a large-scale evaluation of the risk of diabetic ketoacidosis in this population is needed.

To estimate the association between preoperative SGLT2i medication use and postoperative diabetic ketoacidosis in a population of patients who underwent a variety of emergency surgeries. Emergency surgery was chosen given the assumption that a patient would be unable to withhold their SGLT2i medication per the current guidance.

This retrospective cohort study was conducted among a nationwide sample of patients aged 18 years or older with type 2 diabetes who were enrolled in commercial or Medicare fee-for-service insurance plans and who underwent 1 of 13 emergency surgeries between January 1, 2016, and December 15, 2022. Emergency surgeries were defined as those occurring on the same day or the 1 to 2 days after an emergency department claim. Data were analyzed from November 2023 through December 2024.

SGLT2i medication use.

Diabetic ketoacidosis, defined by diagnosis codes, in the 0 to 14 days after surgery.

Among 34 671 patients with type 2 diabetes who underwent emergency surgery (mean [SD] age, 63.9 [14.0] years; 19 175 female [55.3%] and 15 496 male [44.7%]), the most common surgeries were laparoscopic cholecystectomy (9385 patients) and transurethral procedures (12 246 patients). There were 2607 patients (7.5%) who used SGLT2i medications and 32 064 patients (92.5%) who did not. Unadjusted incidence of diabetic ketoacidosis was 127 patients (4.9%) for those exposed to SGLT2i medications and 1115 patients (3.5%) for those unexposed. After accounting for covariates, including demographic characteristics, indicators of diabetic severity, comorbidities, and surgery type, the incidence of the outcome was 3.8% for those exposed to SGLT2i medications and 3.5% for those unexposed. The average treatment effect [ATE] was 0.2% (95% CI, -1.7% to 2.2%). Results were robust to alternate specifications (eg, intensive care unit-level care as the outcome: ATE, -1.0%; 95% CI, -2.9% to 1.1%).

This study found that preoperative use of SGLT2i medications in patients undergoing emergency surgery was not associated with an increased risk for postoperative diabetic ketoacidosis compared with no use of SGLT2i medications. These findings may justify liberalizing current guidance on preoperative SGLT2i medication withholding periods.

Gastric cancer remains a significant global health concern. Radical gastrectomy is the primary curative treatment. Diabetes mellitus is a common comorbidity in patients undergoing surgery for gastric cancer, including radical gastrectomy. Previous studies have suggested that diabetes can negatively affect postoperative outcomes, such as wound healing, infection rates, and overall recovery. However, the specific impact of diabetes on recovery after radical gastrectomy for gastric cancer remains poorly understood. evaluate the influence of diabetes on postoperative recovery, including hospital stay duration, complications, and readmission rates, in patients undergoing gastrectomy for gastric cancer. Understanding these effects could help optimize perioperative management and improve patient outcomes.

To investigate the impact of diabetes on recovery after radical gastrectomy for gastric cancer and associated postoperative outcomes.

This retrospective cohort study was performed at the Endocrinology Department of Xuanwu Hospital, Capital Medical University, Beijing, China. We examined patients who underwent radical gastrectomy for cancer between January 2010 and December 2020. The patients were divided into the diabetes and non-diabetes groups. The main outcomes included length of hospital stay, postoperative complications, and 30-day readmission rate. Secondary outcomes included quality of life indicators. Propensity score matching was used to adjust for potential confounding factors.

A total of 1210 patients were included in the study, with 302 diabetic patients and 908 non-diabetic patients. After propensity score matching, 280 patients were included in each group. Diabetic patients demonstrated significantly longer hospital stays (mean difference 2.3 days, 95%CI: 1.7-2.9, P < 0.001) and higher rates of postoperative complications (OR 1.68, 95%CI: 1.32-2.14, P < 0.001). The 30-day readmission rate was also higher in the diabetic group as compared to the non-diabetic group (12.5% vs 7.8%, P = 0.02).

Patients with diabetes mellitus undergoing radical gastrectomy for gastric cancer experience prolonged hospital stay, increased postoperative complications, and higher readmission rates, thus requiring optimized perioperative management strategies.

Enhanced Recovery Protocol (ERP) has the purpose of minimising postoperative hospitalisation and expediting the restoration of preoperative patient conditions. This study seeks to investigate the correlation between early non-compliance to postoperative items within ERP and complications in liver surgery.

From January 2019 to December 2022 the ERP was proposed to all consecutive patients undergoing liver surgery. Nasogastric tube removal, resuming oral intake and mobilisation and obtaining an adequate glycaemic control were the postoperative items considered as non-compliance indicators. Data were prospectively collected and analysed.

192 patients were included, comprising 99(51.6%) hepatocellular carcinoma, 58(30.2%) colorectal metastasis and 24(12.5%) benign/other pathology. A minimally invasive approach was adopted in 57.3% of cases. Postoperative morbidities occurred in 44.8% of patients, while major complications in 13% of patients. Cirrhosis (p < 0.001), minimally invasive approach (p < 0.004), early oral intake (p < 0.019) and early mobilisation (p < 0.019) significantly correlated to morbidity at multivariate analysis. The complication rate escalated from 26.9% in fully compliant patients, to 58% in patients with two non-compliance indicators and to 91.2% in fully non-compliant patients (p < 0.001). The same trend was confirmed for major complications (p < 0.001).

Early non-compliance to ERP postoperative items in liver surgery was significantly associated with overall and major morbidity.

To evaluate the impact of a proactive action of a specialized diabetes team (SDT) on different health outcomes in patients hospitalized in high complexity surgery units, including solid organ transplant surgical units, of a tertiary hospital.

Nested case control study matched (1:1) by age and gender. The control group consisted of patients (n = 120) who were under the standard of care diabetes management admitted three months' prior the cases. The cases were admitted in the same surgical units (n = 120) and were treated in the setting of the so called "Smart Diabetes Hospital" (SDH) consisting in a SDT that prioritized their actions through a digital map showing blood glucose levels obtained during the previous 24 h.

SDH implementation resulted in a significant reduction in both blood glucose levels (mean 162.1 ± SD 44.4 vs. mean 145.5 ± SD 48.0; p = 0.008) and hypoglycaemic episodes (19.7% vs. 8.4%: p = 0.002). Furthermore, a reduction of 3 days in the length of stay (LOS) was observed (15.6 ± 10.3 vs. 12.4 ± 6.0), which represents a significant cost-saving. Moreover, more new cases of diabetes were detected during the SDT period (2.5% vs. 6.7%, p = 0.04).

SDH is effective in diabetes management and reduce LOS in complex surgical units.

The Comprehensive Complication Index (CCI) is an internationally recognised indicator of postoperative complications. During the perioperative period, patients with diabetes mellitus (DM) or impaired glucose tolerance (IGT) may experience a significant increase in the CCI associated with glucose-related complications and increased mortality. Continuous glucose monitoring (CGM) offers advantages such as portability, accuracy, real-time monitoring and rich information. However, few large-scale studies have investigated the effectiveness and safety of CGM in reducing CCI during major surgeries.

This study is a multicentre, parallel-arm, randomised pragmatic trial to investigate whether CGM improves clinical outcomes in patients with type 1 or type 2 DM or IGT undergoing major surgery relative to conventional monitoring. This study is planned to be conducted in 50 secondary or tertiary hospitals in China. Eligible patients aged 18 years or older with DM or IGT undergoing elective major surgery will be recruited during a baseline screening period of 3 days before surgery. Eligible patients will be randomly assigned to receive CGM or conventional monitoring in a 1:1 ratio. The primary endpoint measure is the CCI score within 30 postoperative days. The margin of superiority is -12.0. A total of 10 168 participants will achieve 90% power to detect a clinically important difference of -13.0 between the means in the primary outcome. This trial includes multiple statistical analysis steps. For the primary outcome, a covariance model will be used to compare the difference in CCI within 30 days postoperatively between the two groups after adjusting for baseline and centre effects.

This trial has been approved by the Ethics Committee of Beijing Tsinghua Changgung Hospital (No. 23684-0-02) and its corresponding branch centres. Informed consent will be obtained from all subjects involved in the study. The primary trial results will be submitted for publication to a peer-reviewed journal.

NCT06331923.

Glucose management is an important component of peri-operative care. The usefulness of continuous glucose monitoring (CGM) in noncardiac surgery is uncertain.

To systematically assess the glycaemic profile and clinical outcome of patients equipped with a CGM device during the peri-operative period in noncardiac surgery.

Systematic review.

Electronic databases were systematically searched up to July 2024.

Any studies performed in the peri-operative setting using a CGM device were included. Closed-loop systems also administering insulin were excluded. Analyses were stratified according to diabetes mellitus status and covered intra-operative and postoperative data. Outcomes included glycaemic profile (normal range 3.9 to 10.0 mmol l -1 ), complications, adverse events, and device dysfunction.

Twenty-six studies (1016 patients) were included. Twenty-four studies were not randomised, and six used a control arm for comparison. In bariatric surgery, diabetes mellitus patients had a mean ± SD glucose of 5.6 ± 0.5 mmol l -1 , with 15.4 ± 8.6% time below range, 75.3 ± 5.5% in range and 9.6 ± 6.7% above range. During major surgery, diabetes mellitus patients showed a mean glucose of 9.6 ± 1.1 mmol l -1 , with 9.5 ± 9.1% of time below range, 56.3 ± 13.5% in range and 30.6 ± 13.9% above range. In comparison, nondiabetes mellitus patients had a mean glucose of 6.4 ± 0.6 mmol l -1 , with 6.7 ± 8.4% time below range, 84.6 ± 15.5% in range and 11.2 ± 4.9% above range. Peri-operative complications were reported in only one comparative study and were similar in CGM and control groups. Device-related adverse events were rare and underreported. In 9.21% of cases, the devices experienced dysfunctions such as accidental removal and issues with sensors or readers.

Due to the limited number of controlled studies, the impact of CGM on postoperative glycaemic control and complications compared with point-of-care testing remains unknown. Variability in postoperative glycaemic profiles and a device dysfunction rate of 1 in 10 suggest CGM should be investigated in a targeted surgical group.

Post-surgical recovery time is influenced by various factors, including patient demographics, surgical details, pre-existing conditions, post-operative care, and socioeconomic status. Understanding these dynamics is crucial for improving patient outcomes. This study aims to identify significant predictors of post-surgical recovery time in a resource-limited Ethiopian hospital setting and to evaluate the variability attributable to individual patient differences and surgical team variations.

A linear mixed model was employed to analyze data from 490 patients who underwent various surgical procedures. The analysis considered multiple predictors, including age, gender, BMI, type and duration of surgery, comorbidities (diabetes and hypertension), ASA scores, postoperative complications, pain management strategies, physiotherapy, smoking status, alcohol consumption, and socioeconomic status. Random effects were included to account for variability at the patient and surgical team levels.

Significant predictors of prolonged recovery time included higher BMI, longer surgery duration, the presence of diabetes and hypertension, higher ASA scores, and major post-operative complications. Opioid pain management was associated with increased recovery time, while inpatient physiotherapy reduced recovery duration. Socioeconomic status also significantly influenced recovery time. The model fit statistics indicated a robust model, with the unstructured covariance structure providing the best fit.

The findings highlight the importance of individualized patient care and the effective management of modifiable factors such as BMI, surgery duration, and postoperative complications. Socioeconomic status emerged as a novel factor warranting further investigation. This study underscores the value of considering patient and surgical team variability in post-surgical recovery analysis, and calls for future research to explore additional predictors and alternative modeling techniques to enhance our understanding of the recovery process.

The type of anesthesia and intensity of pain experienced during surgery are linked to the body's stress response, as reflected in preoperative and postoperative glucose levels.

This comparative study aims to assess the hyperglycemic stress response to cesarean sections performed under different types of anesthesia.

This prospective study included 302 participants, divided into two groups: a general anesthesia group and a spinal anesthesia group. Our primary objective was to investigate the effects of general versus spinal anesthesia on pregnant women undergoing cesarean section. Secondarily, we aimed to assess the impact of other factors on the maternal and neonatal stress response during surgery.

Both groups exhibited a significant proportional increase in mean blood glucose levels after surgery. However, this increase was more pronounced in the general anesthesia group than in the spinal anesthesia group. Therefore, spinal anesthesia had a greater effect in attenuating the hyperglycemic response to surgery during cesarean section compared to general anesthesia. Maternal blood glucose levels were significantly associated with steroid injection, type of anesthesia, and gestational age. In contrast, neonatal blood glucose was significantly associated with gestational age, APGAR score, maternal steroid injection, type of anesthesia, maternal age, and both preoperative and postoperative maternal blood glucose levels.

Spinal anesthesia was superior to general anesthesia in attenuating both maternal and neonatal hyperglycemic responses during the cesarean section. This highlights the significant impact of anesthesia type on maternal and neonatal well-being.

Our study examined the association between the Cambridge Risk Score (CRS), new hyperglycemia (NH), and complications in patients undergoing elective surgery.

In this retrospective cross-sectional study, adult surgical patients, without diabetes, with NH (blood glucose ≥140 mg/dL) were identified, and the CRS was calculated. We used univariate regression models to evaluate the relationship between CRS and NH with 30-day readmission, length of stay (LOS), and complications. Models were stratified by surgical specialty (cardiac/vascular, general, orthopedic, neurologic).

Of 10,531 patients in the study, 24 % had NH. After adjusting for covariates, the CRS was associated with increased odds of complications [OR 2.09; 95%CI:1.69, 2.59] and NH [OR 1.95; 95%CI:1.66, 2.29]. NH was associated with increased odds of 30-day readmission [β 1.60; 95%CI:1.31, 1.96], and increased LOS [β 0.64; 95%CI:0.59, 0.68]. When stratified by surgery type, the CRS was associated with increased LOS in neurosurgery, decreased LOS in orthopedics, and increased odds of complications and NH in neurosurgery and orthopedics.

The CRS is associated with NH, complications, and LOS in patients undergoing elective neurosurgery, orthopedic surgery, and general surgery. This suggests that CRS may have potential to help identify surgical patients at high risk for NH and complications.

Stress hyperglycaemia ratio (SHR) has been reported to be independently and significantly associated with various adverse cardiovascular events as well as mortality. Moreover, in-hospital heart failure following acute myocardial infarction has been demonstrated to account for majority of all heart failure (HF) cases with anterior myocardial infarction showing higher rates of HF. However, the association between SHR and in-hospital HF following an anterior ST-elevation myocardial infarction (STEMI) has not been reported earlier. Therefore, the present study aimed at identifying the relationship between SHR and in-hospital HF post STEMI.

In this retrospective study electronic health records of 512 patients who presented with anterior STEMI from 01 January 2022 to 31 January 2024 were analysed. Based on the development of in-hospital HF, the enrolled patients were stratified into two groups: Group I, comprising of 290 patients who developed in-hospital HF and Group II comprising of 222 patients who did not develop in-hospital HF. ROC and Multivariable logistic regression analyses were performed to assess the relationship between SHR and in-hospital HF.

The results revealed that SHR is a significant independent predictor of in-hospital HF (OR: 3.53; 95%CI: 2.02-6.15; p < 0.001). Apart from SHR, the results also identified age, nosocomial pneumonia, ventricular fibrillation, LVEF, and NT-pro-BNP levels as other independent predictors. ROC analysis showed that SHR independently had a moderate discriminative power with AUC: 0.683, 95% CI 0.605-0.762; p = 0.04, which was almost comparable to the combined predictive value of other independent risk factors (AUC: 0.726, 95% CI 0.677-0.784). Noticeably, combining SHR and other identified independent predictors demonstrated a significant predictive power (AUC: 0.813, 95% CI 0.757-0.881; p = 0.01).

SHR is an independent predictor for in-hospital HF in anterior wall STEMI patients.

The predictive importance of the stress hyperglycemia ratio (SHR), which is composed of admission blood glucose (ABG) and glycated hemoglobin (HbA1c), has not been fully established in noncardiac surgery. This study aims to evaluate the association and predictive capability the SHR for major perioperative adverse cardiovascular events (MACEs) in noncardiac surgery patients.

Individuals who underwent noncardiac surgical procedures between 2011 and 2020, including both diabetic and non-diabetic patients, were identified in the perioperative medicine database (INSPIRE 1.1) and classified into tertiles based on their SHR. The connection between the SHR and the risk of MACEs was studied using Cox proportional hazards regression analysis, then restricted cubic spline (RCS) was employed to assess the association's form. Additionally, the SHR's incremental predictive utility for MACEs was assessed by the C-statistic, continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI), thereby quantifying the enhancement in predictive accuracy brought by incorporating the SHR into existing risk models. Feature importance and predictive models were generated utilizing the Boruta algorithm and machine learning approaches.

A total of 5609 patients were enrolled. With an upwards shift in SHR vertices, the rate of perioperative MACEs and cardiac death event steadily rose. The RCS analysis for perioperative MACEs and cardiac death event both indicated J-shaped associations. Inflection points occurred at SHR = 0.81 for MACEs and SHR = 0.97 for cardiac death. The model's fit improved significantly, with a continuous NRI of 0.067 (95% CI: 0.025-0.137, P < 0.001) and an IDI of 0.305 (95% CI: 0.155-0.430, P < 0.001). When SHR was added as a categorical variable (> 0.81), the C-statistic increased to 0.785 (95% CI: 0.756-0.814) with a ΔC-statistic of 0.035 (P = 0.009), a continuous NRI of 0.007 (95% CI: 0.000-0.021, P = 0.016), and an IDI of 0.076 (95% CI -0.024-0.142, P = 0.092). In the Boruta algorithm, variables identified as important features in the green area were incorporated into the machine learning models development.

The SHR was related with an increased risk of perioperative MACEs in patients following noncardiac surgery, highlighting its potential as a useful and reliable predictive tool for assessing the risk of perioperative MACEs.

Diastolic heart failure (DHF) and type 2 diabetes mellitus (T2DM) often coexist, causing increased mortality rates. Glycaemic variability (GV) exacerbates cardiovascular complications, but its impact on outcomes in patients with DHF and T2DM remains unclear. This study examined the relationships between GV with mortality outcomes, and developed a machine learning (ML) model for long-term mortality in these patients.

Patients with DHF and T2DM were included from the Medical Information Mart for Intensive Care IV, with admissions (2008-2019) as primary analysis cohort and admissions (2020-2022) as external validation cohort. Multivariate Cox proportional hazards models and restricted cubic spline analyses were used to evaluate the associations of GV with 90-day, 1-year, and 3-year all-cause mortality. The primary analysis cohort was split into training and internal validation cohorts, then developing ML models for predicting 1-year all-cause mortality in training cohort, which were validated using the internal and external validation cohorts.

2,128 patients with DHF and T2DM were included in primary analysis cohort (meidian age 71.0years [IQR: 62.0-79.0]; 46.9% male), 498 patients with DHF and T2DM were included in the external validation cohort (meidian age 75.0years [IQR: 67.0-81.0]; 54.0% male). Multivariate Cox proportional hazards models showed that high GV tertiles were associated with higher risk of 90-day (T2: HR 1.45, 95%CI 1.09-1.93; T3: HR 1.96, 95%CI 1.48-2.60), 1-year (T2: HR 1.25, 95%CI 1.02-1.53; T3: HR 1.54, 95%CI 1.26-1.89), and 3-year (T2: HR 1.31, 95%CI: 1.10-1.56; T3: HR 1.48, 95%CI 1.23-1.77) all-cause mortality, compared with lowest GV tertile. Chronic kidney disease, creatinine, potassium, haemoglobin, and white blood cell were identified as mediators of GV and 1-year all-cause mortality. Additionally, GV and other clinical features were pre-selected to construct ML models. The random forest model performed best, with AUC (0.770) and G-mean (0.591) in internal validation, with AUC (0.753) and G-mean (0.599) in external validation.

GV was determined as an independent risk factor for short-term and long-term all-cause mortality in patients with DHF and T2DM, with a potential intervention threshold around 25.0%. The ML model incorporating GV demonstrated strong predictive performance for 1-year all-cause mortality, highlighting its importance in early risk stratification management of these patients.

Postoperative pneumonia (POP) is a common complication after hip fracture surgery and is associated with increased mortality and other complications in elderly patients. This study aims to evaluate biomarkers, especially the glucose-albumin ratio (GAR), for predicting POP in elderly hip fracture patients. A total of 1279 elderly patients admitted to our hospital with hip fractures were included. We assessed 29 biomarkers and focused on GAR to determine its prognostic and predictive value for POP. Multivariable logistic regression and propensity score-matched analyses were conducted to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for POP, adjusting for potential confounders. Receiver operating characteristic (ROC) curves were utilized to determine the optimal cut-off of GAR for predicting POP. Among the biomarkers and combinations assessed, GAR demonstrated superior predictive capability for POP in elderly hip fracture patients. ROC analyses showed moderate predictive accuracy of GAR for POP, with an area under the curve of 0.750. Using the optimal cut-off of 0.175, the high GAR group was significantly associated with increased odds of POP (adjusted OR 2.14, 95%, CI 1.50-3.05). These associations remained significant after propensity score matching and subgroup analyses. Dose-response relationships between GAR and POP were observed. In conclusion, GAR may be a promising biomarker to predict POP risk in elderly hip fracture patients. Further studies are warranted to validate its clinical utility. However, this study has certain limitations, including its retrospective design, potential for selection bias due to the exclusion criteria, and the single-center nature of the study, which should be addressed in future prospective, multicenter studies.

There has been a concerning rise in the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) following noncardiac surgeries (NCS), significantly impacting surgical outcomes and patient prognosis. Glucose metabolism abnormalities induced by stress response under acute medical conditions may be a risk factor for postoperative MACCE. This study aims to explore the association between stress hyperglycemia ratio (SHR) and postoperative MACCE in patients undergoing general anesthesia for NCS.

There were 12,899 patients in this perioperative cohort study. The primary outcome was MACCE within 30 days postoperatively, defined as angina, acute myocardial infarction, cardiac arrest, arrhythmia, heart failure, stroke, or in-hospital all-cause mortality. Kaplan-Meier curves visualized the cumulative incidence of MACCE. Cox proportional hazard models were utilized to assess the association between the risk of MACCE and different SHR groups. Restricted cubic spline analyses were conducted to explore potential nonlinear relationships. Additionally, exploratory subgroup analyses and sensitivity analyses were performed.

A total of 592 (4.59%) participants experienced MACCE within 30 days after surgery, and 1,045 (8.10%) within 90 days. After adjusting for confounding factors, compared to the SHR T2 group, the risk of MACCE within 30 days after surgery increased by 1.34 times (95% CI 1.08-1.66) in the T3 group and by 1.35 times (95% CI 1.08-1.68) in the T1 group respectively. In the non-diabetes group, the risk of MACCE within 30 days after surgery increased by 1.60 times (95% CI 1.21-2.12) in the T3 group and by 1.61 times (95% CI 1.21-2.14) in the T1 group respectively, while no statistically significant increase in risk was observed in the diabetes group. Similar results were observed within 90 days after surgery in the non-diabetes group. Additionally, a statistically significant U-shaped nonlinear relationship was observed in the non-diabetes group (30 days: P for nonlinear = 0.010; 90 days: P for nonlinear = 0.008).

In this large perioperative cohort study, we observed that both higher and lower SHR were associated with an increased risk of MACCE within 30 and 90 days after NCS, especially in patients without diabetes. These findings suggest that SHR potentially plays a key role in stratifying cardiovascular and cerebrovascular risk after NCS.

Surgery induces a stress response, causing insulin resistance that may result in postoperative hyperglycemia, which is associated with increased incidence of complications, longer hospitalization, and greater mortality.

This study examined the effect of metformin treatment on the percentage of patients experiencing postoperative hyperglycemia after elective colon cancer surgery.

This was a randomized, double-blind, placebo-controlled trial.

The study was conducted at Slagelse Hospital in Slagelse, Denmark.

Patients without diabetes planned for elective surgery for colon cancer were included.

Patients received metformin (500 mg 3× per day) or placebo for 20 days before and 10 days after surgery.

Blood glucose levels were measured several times daily until the end of postoperative day 2. The main outcome measures were the percentage of patients who experienced at least 1 blood glucose measurement >7.7 and 10 mmol/L, respectively. Rates of complications within 30 days of surgery and Quality of Recovery-15 scores were also recorded.

Of the 48 included patients, 21 patients (84.0%) in the placebo group and 18 patients (78.3%) in the metformin group had at least 1 blood glucose measurement >7.7 mmol/L ( p = 0.72), and 13 patients (52.0%) in the placebo group had a measurement >10.0 mmol/L versus 5 patients (21.7%) in the metformin group ( p = 0.04). No differences in complication rates or Quality of Recovery-15 scores were seen.

The number of patients in the study was too low to detect a possible difference in postoperative complications. Blood glucose was measured as spot measurements instead of continuous surveillance.

In patients without diabetes, metformin significantly reduced the percentage of patients experiencing postoperative hyperglycemia, as defined as spot blood glucose measurements >10 mmol/L after elective colon cancer surgery. See Video Abstract .

Patients with hyperglycemia, thyroid dysfunction, and adrenal insufficiency face increased perioperative risk, which may be mitigated by appropriate management. This review addresses preoperative glycemic control, makes evidence-based recommendations for the increasingly complex perioperative management of noninsulin diabetes medications, and provides guideline-supported strategies for the perioperative management of insulin, including suggested indications for continuous intravenous insulin. The authors propose a strategy for determining when surgery should be delayed in patients with thyroid dysfunction and present a matrix for managing perioperative stress dose corticosteroids based on the limited evidence available.

The study aimed to investigate the interaction of intraoperative stress hyperglycemia with monocyte functions and their impact on major adverse events (MAEs) in acute aortic dissection (AAD) patients who underwent open repair surgery.

A total of 321 adults who underwent open surgery for AAD at two tertiary medical centers in China were enrolled in the study. The primary endpoint was defined as the incidence and characteristics of perioperative stress hyperglycemia. The secondary endpoints included the incidence of postoperative MAEs, postoperative monocyte counts and inflammatory cytokine expression. Multi-logistic, linear regression and receiver operating characteristic (ROC) curve analyses were used to establish relationships between intraoperative time-weighted average glucose (TWAG), day-one postoperative monocyte counts, serum inflammatory cytokines and postoperative outcomes. In addition, in vitro experiments were conducted to evaluate changes in the inflammatory features of monocytes under high glucose conditions.

Intraoperative hyperglycemia, as indicated by a TWAG level over 142 mg/dL, was associated with elevated postoperative monocyte counts and inflammatory cytokines, which correlated with extended intensive care unit (ICU) stays and worsened outcomes. In vitro, high glucose treatment induced mitochondrial impairment in monocytes, increased the release of inflammatory cytokines and the proportion of classical monocytes from AAD patients.

Intraoperative stress hyperglycemia, in combination with day-one postoperative monocyte counts, were clinically significant for predicting adverse outcomes in AAD patients undergoing open repair surgery. Elevated glucose concentrations shaped the inflammatory features of monocytes in AAD by impairing mitochondrial functions.

Cardiopulmonary bypass (CPB) is a common procedure in cardiac surgery. CPB is a high-risk factor for acute kidney injury (AKI), and diabetes is also such a factor. Diabetes can lead to copper overload. It is currently unclear whether AKI after CPB in diabetic patients is related to copper overload.

To explore whether the occurrence of CPB-AKI in diabetic patients is associated with cuproptosis.

Blood and urine were collected from clinical diabetic and non-diabetic patients before and after CPB. Levels of copper ion, lactate, glucose, heat shock protein-70 (HSP-70), and dihydrolipoamide dehydrogenase (DLAT) were determined. A diabetic rat model was established and CPB was performed. The rats were assessed for the development of CPB-AKI, and for the association of AKI with cuproptosis by detecting copper levels, iron-sulfur cluster proteins and observation of mitochondrial structure by electron microscopy.

CPB resulted in elevations of copper, lactate, HSP-70 and DLAT in blood and urine in both diabetic and non-diabetic patients. CPB was associated with pathologic and mitochondrial damage in the kidneys of diabetic rats. Cuproptosis-related proteins also appeared to be significantly reduced.

CPB-AKI is associated with cuproptosis. Diabetes mellitus is an important factor aggravating CPB-AKI and cuproptosis.

Hyperglycemia in hospital inpatients without pre-existing diabetes is associated with increased mortality. However, the independent contribution of hyperglycemia to health care-associated infection (HAI), acute kidney injury (AKI), and stroke is unclear.

To investigate the relationship between hyperglycemia and adverse clinical outcomes in hospital for patients with and without diabetes.

Diabetes IN-hospital: Glucose and Outcomes (DINGO) was a 26-week (October 2019-March 2020) prospective cohort study. Clinical and glucose data were collected up to the 14th day of admission. Primary stratification was by hyperglycemia, defined as ≥2 random capillary blood glucose (BG) measurements ≥11.1 mmol/L (≥200 mg/dL). Propensity weighting for 9 clinical characteristics was performed to allow interrogation of causality. To maintain the positivity assumption, patients with HbA1c >12.0% were excluded and prehospital treatment not adjusted for. The setting was the Royal Melbourne Hospital, a quaternary referral hospital in Melbourne, Australia. Admissions with at least 2 capillary glucose values and length of stay >24 hours were eligible, with half randomly sampled. Outcome measures were HAI, AKI, stroke, and mortality.

Of 2558 included admissions, 1147 (45%) experienced hyperglycemia in hospital. Following propensity-weighting and adjustment, hyperglycemia in hospital was found to, independently of 9 covariables, contribute an increased risk of in-hospital HAI (130 [11.3%] vs 100 [7.1%], adjusted odds ratio [aOR] 1.03, 95% CI 1.01-1.05, P = .003), AKI (120 [10.5%] vs 59 [4.2%], aOR 1.07, 95% CI 1.05-1.09, P < .001), and stroke (10 [0.9%] vs 1 [0.1%], aOR 1.05, 95% CI 1.04-1.06, P < .001).

In hospital inpatients (HbA1c ≤12.0%), irrespective of diabetes status and prehospital glycemia, hyperglycemia increases the risk of in-hospital HAI, AKI, and stroke compared with those not experiencing hyperglycemia.

While preliminary evidence for use of real-time continuous glucose monitoring (rtCGM) in the hospital setting is encouraging, challenges with currently available devices and technology will need to be overcome as part of real-world integration. This paper reviews the current evidence and guidelines regarding use of rtCGM in the hospital and suggests a practical approach to implementation.

There is now a considerable body of real-world evidence on the benefits of reducing dysglycemia in the hospital using both traditional point-of-care (POC) glucose testing and rtCGM. Benefits of rtCGM include decreased frequency of hypo- and hyperglycemia with reduced need of frequent POC checks and it is both feasible and well-accepted by nursing staff and providers. If expansion to additional sites is to be considered, practical solutions will need to be offered. Recommendations for an operational workflow and tools are described to guide implementation in the non-ICU setting. Further testing in randomized controlled trials and real-world dissemination and implementation designs is needed, together with industry and technology collaborations, to further streamline the integration into health systems.

Diabetes mellitus (DM) is a prevalent metabolic disorder associated with various postoperative complications. The association between DM and postoperative opioid use remains unclear, with conflicting evidence in the literature. This systematic review and meta-analysis comprehensively evaluated the association between DM and postoperative opioid consumption, pain sensation, and adverse effects in surgical patients.

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search of electronic databases identified studies investigating the relationship between DM and postoperative pain outcomes. Eligible studies, both prospective and retrospective, were included based on the predefined criteria. Data extraction and quality assessment were performed independently by the authors. Meta-analyses were performed using Review Manager 5.

Among 100 initially identified articles, five studies met the inclusion criteria. In the meta-analysis, 473 participants were included. The results indicated that patients with DM had significantly higher postoperative opioid consumption (standardized mean difference, 0.79; 95% confidence interval, 0.26-1.31; P = 0.003) than those in the control group, with substantial heterogeneity (I2 = 83%). No significant differences in postoperative pain scale scores at rest or during movement were observed. Adverse effects, including nausea, vomiting, and pruritus, showed varied outcomes, whereas overall satisfaction did not differ between the two groups.

This meta-analysis provides evidence that patients with DM undergoing surgery consume more opioids postoperatively. Understanding the association between DM and pain management is crucial for optimizing perioperative care in this patient population.

Type-2 diabetes influences the course and severity of hand infections.

We prospectively examined glucose metabolism in 90 patients with hand infection, distinguishing between normal, prediabetic and diabetic states. HbA1c-levels were evaluated prior to surgery. Patients with normal levels took an oral glucose tolerance test and those diagnosed with prediabetes were retested after the infection subsided. Hospital stay, number of surgical interventions and inflammatory markers were examined per group.

Sixty-two patients (68.8%) had abnormal glucose metabolism: 17 (18.9%) with history of diabetes and 11 (12.2%) newly diagnosed. Prediabetes was observed in 34 patients (37.8%). At follow-up, prediabetes and diabetes were diagnosed in 7 cases each, and physiological glucose metabolism was observed in 3 patients. For the 11 patients unable to undergo a second oral glucose tolerance test, detailed phone calls confirmed absence of diabetes. C-reactive protein levels were significantly elevated in diabetic patients compared to those with normal glucose metabolism (p = 0.001) or prediabetes (p = 0.034). Patients with history of diabetes were significantly older than those with normal glucose tolerance (p = 0.001) or prediabetes (p = 0.017). There were no significant intergroup differences in thrombocyte count, length of hospital stay, interval from injury to admission or the number surgical interventions.

Glucose metabolism should be assessed in patients with hand infections and reassessed after the infection has subsided in prediabetic cases.

This study was designed to compare individualized and conventional hyperglycemic thresholds for the risk of acute kidney injury (AKI) after cardiac surgery.

This was an observational study.

The study took place in a single-center tertiary teaching hospital.

Adult patients who underwent cardiac surgery between January 2012 and November 2021 were enrolled.

Two blood glucose thresholds were used to define intraoperative hyperglycemia. While the conventional hyperglycemic threshold (CHT) was 180 mg/dL in all patients, the individualized hyperglycemic threshold (IHT) was calculated based on the preoperative hemoglobin A1c level. Various metrics of intraoperative hyperglycemia were calculated using both thresholds: any hyperglycemic episode, duration of hyperglycemia, and area above the thresholds. Postoperative AKI associations were compared using receiver operating characteristic curves and logistic regression analysis. Among the 2,427 patients analyzed, 823 (33.9%) developed AKI. The C-statistics of IHT-defined metrics (0.58-0.59) were significantly higher than those of the CHT-defined metrics (all C-statistics, 0.54; all p < 0.001). The duration of hyperglycemia (adjusted odds ratio, 1.09; 95% confidence interval, 1.02-1.16) and area above the IHT (1.003; 1.001-1.004) were significantly associated with the risk of AKI, except for the presence of any hyperglycemic episode. None of the CHT-defined metrics were significantly associated with the risk of AKI.

Individually defined intraoperative hyperglycemia better predicted postcardiac surgery AKI than universally defined hyperglycemia. Intraoperative hyperglycemia was significantly associated with the risk of AKI only for the IHT. Target blood glucose levels in cardiac surgical patients may need to be individualized based on preoperative glycemic status.

Both diabetes and cancer are major global health issues that are among the leading causes of morbidity and mortality. There is a high prevalence of diabetes among cancer patients, many of whom require a surgical procedure. This review focuses on the operative complications in patients with diabetes and cancer, and the perioperative management of diabetes in cancer patients.

A literature search of articles in English-published between January 2010 and May 2024-was carried out using the databases PubMed, MEDLINE, Google Scholar, and the Cochrane Database of Systematic Reviews. The search primarily focused on the operative complications in patients with diabetes and cancer, and perioperative management strategies.

The relationship between cancer and diabetes is complex; cancer patients have a high risk of developing diabetes, while diabetes is a risk factor for certain cancers. In addition, various cancer therapies can induce or worsen diabetes in susceptible patients. Many individuals with cancer and diabetes require surgery, and due to underlying diabetes, they may have elevated risks for operative complications. Optimal perioperative management for these patients includes managing perioperative glycemia and other comorbid illnesses, adjusting diabetic and cancer treatments, optimizing nutrition, minimizing the duration of fasting, supporting early mobilization, and providing patient education to enable self-management.

While evidence is limited, optimal perioperative management for patients with both diabetes and cancer is necessary in order to reduce surgical complications. Future studies are needed to develop evidence-informed perioperative strategies and improve outcomes for these patients.

With the increasing prevalence of obesity and morbid obesity, this subgroup's contribution to patients presenting for elective procedures requiring sedation is significant. Gastrointestinal (GI) procedures clearly form the largest group of such procedures. These procedures may be intended to treat obesity such as the insertion of an intragastric balloon or one or more unrelated procedures such as a screening colonoscopy and (or) diagnostic/therapeutic endoscopy. Regardless of the procedure, these patients pose significant challenges in terms of choice of sedatives, dosing, airway management, ventilation, and oxygenation. An understanding of dissimilarity in the handling of different groups of medications used by an anesthesia provider and alterations in airway anatomy is critical for providing safe sedation. Administration of sedative medications and conduct of anesthesia requires dose modifications and airway adjuncts. In this review, we discuss the above issues in detail, with a particular focus on GI endoscopy.

Enteral nutrition (EN) support therapy increases the risk of abnormal blood glucose (BG). The aim of this study is to evaluate the clinical value of a real-time continuous glucose monitoring (rt-CGM) system in BG monitoring during postoperative EN support therapy in patients with esophageal cancer.

Patients without diabetes mellitus (DM) with esophageal cancer who planned to receive postoperative EN were enrolled. With the self-monitoring of BG value as the reference BG, the accuracy of rt-CGM was evaluated by the mean absolute relative difference (MARD) value, correlation efficient, agreement analysis, and Parkes and Clarke error grid plot. Finally, paired t tests were used to compare the differences in glucose fluctuations between EN and non-EN days and slow and fast days.

The total MARD value of the rt-CGM system was 13.53%. There was a high correlation between interstitial glucose and fingertip capillary BG (consistency correlation efficient = 0.884 [95% confidence interval, 0.874-0.894]). Results of 15/15%, 20/20%, 30/30% agreement analysis were 58.51%, 84.71%, and 99.65%, respectively. The Parkes and Clarke error grid showed that the proportion of the A and B regions were 100% and 99.94%, respectively. The glucose fluctuations on EN days vs non-EN days and on fast days vs slow days were large, and the difference was statistically significant (P < 0.001).

The rt-CGM system achieved clinical accuracy and can be used as a new option for glucose monitoring during postoperative EN therapy. The magnitude of glucose fluctuation during EN therapy remains large, even in the postoperative population without DM.

The target glycemic control for nondiabetic patients in the postanesthesia care unit (PACU) after hysteroscopic surgery remains unclear. Our goal is to determine the optimal level of glycemic control by finding the relationship between blood glucose level (BGL) leaving the PACU and postoperative hypoglycemia in nondiabetic patients.

This retrospective cohort study was conducted at a comprehensive tertiary hospital in Chongqing, China between June 2018 and December 2020.

The target independent and dependent variables were BGL leaving the PACU and postoperative hypoglycemia, respectively. The primary outcome was the incidence of hypoglycemia. Logistic regression was used to explore the association between discharge BGL and hypoglycemia. The optimal glycemic control range was determined by using the receiver operating characteristic (ROC) curve.

Prior to insulin use, BGL in the insulin-using subgroup might be as high as 20 mmol/L. Hypoglycemia was related to the BGL while leaving the PACU (odds ratio (OR) 0.37 [95% confidence interval (CI) 0.22 to 0.65]). The best cut-off value (12.95 mmol/L) was determined by fitting the ROC curve.

If severe hyperglycemia develops during hysteroscopic surgery in individuals with 5% glucose as the mediator of uterine distention, the recommendation is to maintain blood glucose above 12.95 mmol/L when treated with insulin.

Glucagon-like peptide-1 agonist receptors (GLP-1RAs), medications used for glycemic control and weight loss, are increasing worldwide. In the perioperative period, the major concern related to GLP-1RA is gastric emptying delay and risk of aspiration. This meta-analysis and systematic review compared the risks and benefits of using GLP-1 agonist receptors and control in surgical and nonsurgical procedures under anesthesia or sedation.

We systematically searched MEDLINE, Embase, and Cochrane for randomized controlled trials and observational studies involving patients > 18 years undergoing elective surgeries or procedures. Outcomes of interest were pre-procedural gastrointestinal (GI) symptoms, residual gastric content assessed by endoscopy, pulmonary aspiration during anesthesia/sedation, perioperative glycemic control, postoperative inotropic support, nausea/vomiting (PONV), atrial fibrillation, and 30-day mortality rate. We used a random effects model, with odds ratio and mean difference computed for binary and continuous outcomes, respectively.

Fourteen randomized and observational studies with 2143 adult patients undergoing elective surgeries and procedures were included. GLP-1RA resulted in increased pre-procedural GI symptoms (OR 7.66; 95% CI 3.42, 17.17; p < 0.00001; I2 = 0%) and elevated residual gastric content (OR 6.08; 95% CI 2.86, 12.94; p < 0.00001; I2 = 0%). GLP-1RA resulted in lower glycemic levels (MD - 0.73; 95% CI - 1.13, - 0.33; p = 0.0003; I2 = 90%) and lower rate of rescue insulin administration (OR 0.39; 95% CI 0.23, 0.68 p = 0.0009; I2 = 35%). There was no significant difference in rate of perioperative hypoglycemia (OR 0.60; 95% CI 0.29, 1.24; p = 0.17; I2 = 0%), hyperglycemia (OR 0.89; 95% CI 0.59, 1.34; p = 0.58; I2 = 38%), need for postoperative inotropic support (OR 0.57; 95% CI 0.33, 1.01; p = 0.05; I2 = 0%), atrial fibrillation (OR 1.02; 95% CI 0.52, 2.01; p = 0.95; I2 = 16%), rate of PONV (OR 1.35; 95% CI 0.82, 2.21; p = 0.24; I2 = 0%), and 30-day mortality rate (OR 0.54; 95% CI 0.14, 2.05; p = 0.25; I2 = 0%).

Compared to control, pre-procedural GLP-1RA increased the rate of GI symptoms and the risk of elevated residual gastric content despite adherence to fasting guidelines. GLP-1RA improved glycemic control and decreased the rate of rescue insulin administration. There was no significant difference in the rates of perioperative hypo or hyperglycemia, postoperative inotropic support, PONV, atrial fibrillation, and 30-day mortality.