A diabetic patient on long-term insulin is scheduled for major abdominal surgery. Which perioperative glucose target is recommended by current guidelines to balance hypoglycaemia risk against hyperglycaemia-related infections?

• A 80–110 mg/dL (tight control protocol)
• B 180–250 mg/dL
• C Below 80 mg/dL to prevent surgical site infection
• D 140–180 mg/dL ✓

Explanation

Current perioperative guidelines (STS, ADA, SCCM) recommend a target blood glucose of 140–180 mg/dL in surgical patients. The landmark NICE-SUGAR trial showed that tight control (80–110 mg/dL) increased 90-day mortality due to severe hypoglycaemic episodes. Moderate hyperglycaemia (140–180 mg/dL) balances the risk of infection from hyperglycaemia against the risk of hypoglycaemia-induced cerebral injury. Levels above 180 mg/dL impair wound healing and leucocyte function.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

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