Glycemic Control Assessment for Major Surgery
Yes, this patient has reasonably controlled diabetes for major surgery with an HbA1c of 7.5%, which falls within the acceptable perioperative range of 6-8%. 1
HbA1c Interpretation for Surgical Clearance
The French Society of Anesthesia and Intensive Care (SFAR) guidelines explicitly state that an HbA1c value between 6-8% is reassuring about the quality of long-term treatment and patient compliance, allowing surgery to proceed with close perioperative glycemic monitoring. 1 This patient's HbA1c of 7.5% falls squarely within this acceptable range.
Surgery should be postponed only when HbA1c is >8% or <6%, as these values indicate either poor glycemic control with substantially increased perioperative morbidity/mortality risk, or excessive hypoglycemia risk from overtreatment, respectively. 1, 2
Fructosamine Correlation
The fructosamine level of 232 µmol/L is below the upper limit of normal (<280 µmol/L), which corroborates the acceptable HbA1c finding and confirms reasonable short-term (2-3 week) glycemic control. 3 This concordance between HbA1c and fructosamine is particularly valuable because:
- Fructosamine reflects more recent glycemic control (2-3 weeks vs. 3 months for HbA1c), ensuring no recent deterioration has occurred 4, 5
- Both markers predict perioperative complications to a similar extent in surgical patients 3
- The agreement between these two markers rules out conditions that might falsely lower HbA1c (hemolytic anemia, hemoglobinopathies) 4
Perioperative Management Strategy
Preoperative Requirements
- Measure capillary blood glucose on the day of surgery to ensure levels are <10 mmol/L (180 mg/dL), as this threshold decreases risk of death, infection, and prolonged hospital stay 1
- Screen for recent hypoglycemic episodes in the preceding week, as these would require additional precautions despite acceptable HbA1c 1
- Assess for diabetic complications including cardiovascular disease, nephropathy (measure GFR), and autonomic neuropathy that increase perioperative risk 1
Intraoperative Targets
- Maintain blood glucose 7.8-10.0 mmol/L (140-180 mg/dL) during surgery, with hourly glucose monitoring 6
- Continue insulin therapy throughout the perioperative period without interruption, as insulin deficiency in insulin-dependent patients leads to ketoacidosis within hours 1
Postoperative Protocol
- Resume oral feeding as quickly as possible to facilitate return to usual insulin regimen 1
- Monitor for hypoglycemia, as postoperative drowsiness may be mistaken for anesthesia effects when it actually represents dangerous hypoglycemia 6, 7
Critical Caveats
Do not assume this patient is safe based solely on HbA1c—you must verify:
- Day-of-surgery glucose <10 mmol/L (180 mg/dL), as recent glycemic instability can occur despite acceptable HbA1c 1
- Absence of recent hypoglycemic episodes, particularly in insulin-treated patients who may have hypoglycemia unawareness 1
- No evidence of ketosis or recent hyperglycemic episodes, which would indicate acute decompensation requiring postponement 1
The concordance between HbA1c (7.5%) and fructosamine (232 µmol/L) provides strong evidence that this patient's diabetes is adequately controlled for major surgery, assuming no acute glycemic instability on the day of surgery and appropriate perioperative insulin management. 1, 3