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Fearon et al. Metab Target Organ Damage 2022;2:13 Metabolism and
DOI: 10.20517/mtod.2022.12
Target Organ Damage

Review Open Access

Glycaemic control strategies in people with type 2
diabetes mellitus undergoing elective surgery

Naomi M. Fearon , Dimitri J. Pournaras

Department of Bariatric Surgery, Southmead Hospital, North Bristol Trust, Bristol, BS10 5NB, United Kingdom.
Correspondence to: Dr. Naomi M. Fearon, Department of Bariatric Surgery, Southmead Hospital, North Bristol Trust, Bristol,
BS10 5NB, United Kingdom. E-mail: naomifearon@rcsi.ie

How to cite this article: Fearon NM, Pournaras DJ. Glycaemic control strategies in people with type 2 diabetes mellitus
undergoing elective surgery. Metab Target Organ Damage 2022;2:13. https://dx.doi.org/10.20517/mtod.2022.12

Received: 27 May 2022 Revised: 19 Aug 2022 Accepted: 30 Aug 2022 Published: 6 Sep 2022

Academic Editor: Ketan K. Dhatariya Copy Editor: Haixia Wang Production Editor: Haixia Wang

Abstract
People with diabetes mellitus (DM) undergo more elective surgery than those without DM; however, up to half of
the patients are undiagnosed when referred for surgery. This is an opportunity to intervene and instigate a
management plan. Preoperative strategies may vary based on coexisting medical diseases such as obesity and the
availability of resources with the aim of achieving glycaemic control while also treating coexisting conditions. In the
context of obesity, there is substantial overlap in some of the treatment strategies. Guidelines, such as those from
the UK Centre for Perioperative Medicine, suggest target glycated haemoglobin levels, preoperative fasting blood
glucose levels, and when to defer an elective operation or instigate treatment to proceed if deemed safe.
Preoperatively glycaemic control is often achieved pharmacologically, and newer agents, including glucagon-like
peptide one receptor agonists (GLP1-RA) and sodium-glucose co-transporter 2 (SGLT2) inhibitors, are emphasised
in the preoperative management of diabetes mellitus, particularly if obesity is also present. A very low-energy diet
is an underutilised but well-evidenced method of achieving both glycaemic control and weight loss with a
particularly dominant effect on liver fat which is helpful for people who are due to undergo abdominal surgery.
Bariatric-metabolic procedures are of growing interest as bridging interventions to surgery and are more commonly
used for obesity, but they also have a well-recognized impact on the improvement and remission of DM. This
review gives an overview of the necessity of preoperative identification of DM and strategies for management.
Intra-operative glycaemic control is also discussed, and the role of stress hyperglycaemia perioperatively.

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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