Perioperative blood glucose fluctuations are a key factor affecting surgical safety and patient prognosis. Data shows that among non-endocrinology surgical patients, approximately 30% have stress-induced hyperglycemia, with over 60% having no history of diabetes. Uncontrolled hyperglycemia can increase the risk of postoperative infection by three times and prolong hospital stays by 50%. Traditional perioperative blood glucose monitoring (BGM) mostly relies on the “passive detection” mode – blood glucose is only detected during preoperative screening or when typical symptoms occur, resulting in approximately 40% of latent hyperglycemia being missed. With the popularization of the concept of Enhanced Recovery after Surgery (ERAS), perioperative blood glucose management is shifting from “passively responding to outliers” to “actively preventing risks”, and this paradigm reconfiguration has put forward new requirements for non-endocrinology clinical practice.
1. Limitations of passive detection Mode: From “lagging response” to “Risk blind spot”
The core contradiction of perioperative BGM in traditional non-endocrinology departments lies in the mismatch between “passivity” and “high risk”, which is specifically manifested in three limitations:
1.1 Fragmented monitoring timing
Before the operation, only fasting blood glucose was routinely detected, while the dynamic impact of surgical stress (such as trauma, anesthesia, and inflammatory response) on blood glucose was ignored. Studies have shown that within two hours after the start of surgery, the blood glucose of approximately 58% of patients without a history of diabetes will significantly increase (>8.3mmol/L) due to the release of catecholamines, while the intraoperative blood glucose monitoring rate under the traditional model is less than 20%.
1.2 Isolated data interpretation
Non-endocrinology medical staff have a vague understanding of the intervention threshold for abnormal blood glucose. They often equate the “diagnostic criteria for diabetes” (fasting blood glucose ≥7.0mmol/L) with the “perioperative safety threshold”. In fact, the perioperative blood glucose control target needs to be individualized: for neurosurgical operations, it is recommended to maintain it at 4.4-6.1mmol/L, while for major orthopedic surgeries, it can be relaxed to 8.3mmol/L. The passive detection mode lacks dynamic adjustment of the target value.
1.3 Lagging intervention measures
Intervention is initiated only when blood glucose levels rise significantly (such as >11.1mmol/L) or when acute conditions like ketosis and coma occur, thus missing the best regulatory window. A multicenter study showed that the average delay from abnormal blood glucose to insulin intervention in non-endocrinology patients reached 4.2 hours, significantly increasing the risk of postoperative delirium and deep vein thrombosis.
2. The core of the active management paradigm: Building a “full-cycle – multi-dimensional” monitoring system
Active management, with “prevention first and dynamic regulation” at its core, achieves full control of perioperative blood glucose through the integration of technical tools, process optimization and multi-disciplinary collaboration. Its connotation can be summarized as “three initiatives” :
2.1 Active Risk Stratification: Precise preoperative identification of high-risk groups
A risk scoring model was constructed based on the patient’s underlying diseases (such as hypertension and obesity), surgical types (such as open abdominal surgery and cardiac surgery), and anesthesia methods (general anesthesia vs local anesthesia). For instance, by using the “Perioperative Hyperglycemia Risk Score Sheet” (including indicators such as age ≥65 years old, BMI≥28kg/m², and operation time >3 hours), continuous glucose monitoring (CGM) was initiated 24 hours in advance for high-risk patients, which increased the detection rate of latent hyperglycemia to 82%.
2.2 Active Dynamic Monitoring: Real-time intraoperative and postoperative early warning
Breaking through the limitations of “point detection”, a “continuous monitoring + immediate feedback” mode is adopted: During the operation, blood glucose is monitored every 1-2 hours through a bedside rapid blood glucose meter, and the dosage of the insulin pump is adjusted in combination with parameters such as the depth of anesthesia and blood loss. After being transferred to the PACU after the operation, the CGM device was used to transmit data in real time. When the blood glucose was greater than 10.0mmol/L, the early warning at the nursing end was automatically triggered, and the intervention response time was shortened to within 30 minutes.
2.3 Proactive multi-disciplinary collaboration: Breaking down departmental barriers
Establish a joint management team of “Endocrinology Department – Surgery Department – Anesthesiology Department” : Before the operation, the endocrinology department formulates individualized blood glucose control plans (such as basal insulin adjustment). During the operation, the anesthesiology department collaboratively monitors the interaction between hemodynamics and blood glucose. After the operation, surgical nurses adjust the frequency of dressing changes based on the “blood glucose – wound healing” association model. Data shows that multidisciplinary collaboration can reduce the incidence of postoperative hyperglycemia in non-endocrinology patients by 45%.
3. Practical Paths for paradigm Shift: Technological Empowerment and process Reengineering
The implementation of the transition from passive detection to active management requires the innovation of technological tools and the reengineering of clinical processes
3.1 Technical Tools: From “Single-point Detection” to “Intelligent Integration”
Promote portable CGM devices (such as transient scanning blood glucose meters). Their features of no blood collection and real-time data transmission can reduce patients’ suffering. At the same time, through the hospital information system (HIS), they can be connected to electronic medical records to automatically generate “blood glucose – surgical process – medication” correlation curves, assisting medical staff in identifying the causes of blood glucose fluctuations (such as the use of glucocorticoids and infections).
3.2 Process Optimization: Establish standardized monitoring paths
Formulate the “Perioperative BGM Management Process for Non-endocrinology Departments” :
Preoperative: All patients completed the HbA1c test. Those at high risk (HbA1c≥6.5% or risk score ≥5 points) entered the intensive monitoring process.
During the operation: Blood glucose should be monitored every hour for patients under general anesthesia and every 2 hours for those under local anesthesia.
Postoperatively: ICU patients continue with CGM, while patients in general wards monitor their fasting blood glucose and 2-hour post-meal blood glucose every day until 24 hours before discharge.
3.3 Capacity Building: Enhance the professional quality of non-endocrinology medical staff
Through the “theoretical training + scenario simulation” model, three key capabilities are emphasized and strengthened:
① Stratification of blood glucose targets (such as neurosurgery vs. general surgery);
② Insulin usage calculation (such as adjusting the dosage of short-acting insulin based on blood glucose levels);
③ Emergency treatment for hypoglycemia (such as the 15-15 principle: 15g of carbohydrates, retest after 15 minutes).
4. Challenges and Countermeasures: Solving the Practical Predicament of blood glucose Management in Non-Endocrinology Departments
The active management model faces three major challenges in promotion and needs to be broken through specifically:
4.1 Misconception: “Non-endocrinology departments do not need refined blood sugar control”
Countermeasures: Strengthen the consensus that “blood glucose management is a core link in surgical safety” by embedding clinical pathways (such as forcing blood glucose monitoring prompts to pop up in the electronic medical record system) and regularly publishing the blood glucose compliance rate and complication data of the department.
4.2 Resource Constraints: Insufficient monitoring equipment and manpower
Countermeasures: Adopt a “graded monitoring” strategy – CGM is used for high-risk patients, while bedside rapid blood glucose meters are used for medium and low-risk patients. At the same time, surgical nurses are trained to undertake basic blood glucose monitoring and initial intervention, and endocrinologists provide technical support through remote consultation.
4.3 Patient Compliance: Resistance to frequent monitoring
Countermeasures: Enhance compliance through preoperative education (such as “For every 1mmol/L reduction in blood glucose, the risk of infection decreases by 18%”), providing painless monitoring equipment (such as CGM), and setting up a “blood glucose target achievement reward mechanism” (such as prioritizing surgery).
blood glucose analyzer, blood glucose machine, blood glucose kit
Post time: Jan-26-2026