In cases of perioperative hyperglycemia, which patient demographic is at the highest risk?

Diabetic patients are at the highest risk for perioperative hyperglycemia due to their pre-existing condition that affects glucose metabolism and insulin response. Individuals with diabetes often have impaired insulin secretion or action, making it difficult for their bodies to maintain normal blood glucose levels, particularly under the stress of surgery. During the perioperative period, factors such as stress, hormonal changes, and dietary modifications can further exacerbate hyperglycemia in these patients.

While obesity, advanced age, and the absence of cardiac disease can influence a patient's risk for various postoperative complications, they do not inherently predispose patients to hyperglycemia in the same direct manner that diabetes does. Obese patients might have insulin resistance but are not guaranteed to have diabetes, and thus their risk for hyperglycemia is lower compared to those with an established diagnosis. Similarly, older patients may have metabolic changes that could affect glucose levels, but again, the primary concern is with those who already have diabetes. Patients without cardiac disease may have a different set of risks related to their surgery but are not specifically at increased risk for perioperative hyperglycemia.

Therefore, understanding the underlying mechanisms of diabetes and its effects on glucose regulation highlights why diabetic patients are of particular concern in managing perioperative hyperglycemia