Perioperative diabetes care in 2026

Diabetes mellitus is one of the most common chronic diseases in surgical patients, affecting approximately one in five surgical patients. Surgery and anesthesia trigger a physiological stress response that disrupts glucose regulation and can lead to perioperative hyperglycemia, which increases the risk of surgical site infections, delayed wound healing, longer hospital stays, and higher mortality. Recommendations include hemoglobin A1c (HbA1c) testing within three months before surgery and treatment of blood glucose levels above 180 mg/dL with insulin. Recent evidence suggests that continuing metformin throughout the perioperative period is safe in many patients. The most debated medications are GLP-1 receptor agonists (such as semaglutide and tirzepatide), which slow gastric emptying; however, a 2025 meta-analysis involving more than 185,000 patients found no statistically significant increase in pulmonary aspiration events.