PERIOPERATIVE GLYCEMIC CONTROL AND POSTOPERATIVE COMPLICATIONS IN DIABETIC PATIENTS UNDERGOING GENERAL ANESTHESIA: A SYSTEMATIC REVIEW

Abstract

Background: Diabetic patients undergoing general anesthesia face heightened risks of postoperative complications, in part due to dysregulated glycemic control. The influence of perioperative glucose management on surgical outcomes remains clinically significant but variably defined across the literature. Objective: To systematically review the association between perioperative glycemic control and postoperative complications in diabetic patients undergoing general anesthesia, with emphasis on hyperglycemia, hypoglycemia, glycemic variability, and protocol-based management. Methods: This review followed PRISMA 2020 guidelines. Databases including PubMed, Scopus, Embase, Web of Science, and Google Scholar were searched for peer-reviewed studies (2010–2024) examining adult diabetic patients undergoing surgery with general anesthesia. Eligible designs included randomized controlled trials, cohort studies, and case-control studies reporting postoperative complications in relation to perioperative glycemic measures. Quality appraisal was performed using the Newcastle-Ottawa Scale and the Cochrane Risk of Bias Tool. Results: Twenty studies met eligibility criteria. Hyperglycemia (≥180 mg/dL) was consistently associated with increased risk of wound infections, systemic complications, and mortality. HbA1c was predictive of adverse outcomes, while perioperative glycemic variability independently prolonged length of stay and increased mortality. Hypoglycemia, though less common, significantly elevated the risk of severe surgical complications. Structured glycemic management protocols reduced ICU hyperglycemia, shortened time to target glucose, and lowered insulin requirements compared with routine care. Conclusion: Perioperative glycemic control is a critical, modifiable determinant of surgical outcomes in diabetic patients. Moderate glucose targets (140–180 mg/dL), preoperative optimization, and standardized perioperative protocols are recommended. Future multicenter trials and continuous glucose monitoring studies are needed to refine individualized management strategies.