The Prevalence of Hyperglycemia in Surgical Patients With Pre-diabetes

The goal of this study is to measure the prevalence and risks of hyperglycemia in surgical patients with prediabetes. The main questions it aims to answer are:

• What is the prevalence of hyperglycemia in surgical patients with prediabetes?
• What is the relative risk of postoperative complications associated with hyperglycemia?

To answer these questions, surgical patients with prediabetes will undergo universal glucose measurement in the perioperative period. Glucose data will be analyzed in conjunction with electronic health record (EHR) data describing patient outcomes.

Study Overview

• Status: Not yet recruiting
• Conditions: Stress Hyperglycemia; Non-Cardiac/ Non-Thoracic Surgery; Prediabetes or Diabetes; Surgery Complications

Detailed Description

Background

Day-of-surgery and postoperative ('perioperative') hyperglycemia are modifiable risk factors for complications after non-cardiac surgery, including surgical site infections, 30-day readmissions, and mortality. Data from Alberta suggests perioperative hyperglycemia is common among people without diabetes, affecting about 13% of people with prediabetes on the day-of-surgery and 18% of people without diabetes after surgery. Paradoxically, the risks of perioperative hyperglycemia appear to be two-times greater for people with prediabetes than for people with diabetes and the reasons for this are unknown. Current estimates of the prevalence of perioperative for people with prediabetes are limited. Understanding the true prevalence would inform individual decision-making around surgery, the need for further research about the true association of hyperglycemia and adverse outcomes, and clinical decisions about the utility of measuring glucose for all people with prediabetes around the time of surgery.

Objectives

This prospective cohort study will establish the prevalence of perioperativehyperglycemia in people with prediabetes undergoing scheduled (elective and urgent) non-cardiac surgeries. This information will inform:

1. Patients, to better understand their individual risks of elective surgery.
2. Clinicians, on the need for perioperative glucose measurement for patients with prediabetes.
3. Researchers, on the need for and design of further studies.

Methods Overview

We will measure glucose in all adult patients with prediabetes undergoing scheduled (elective and urgent) non-cardiac surgeries throughout the perioperative period (referring to the day of surgery and up to the first 3 postoperative days or discharge, whichever comes first) to determine the prevalence of perioperative dysglycemia in people with prediabetes.

This project will leverage established data sources and linkages to address secondary and exploratory objectives: (1) Use in-hospital insulin prescribing data to describe current practices for treatment of perioperative hyperglycemia in people with prediabetes; (2) Explore the association between clinical outcomes like infections and length of stay with perioperative hyperglycemia in people with prediabetes; and (3) Compare the prevalence of perioperative hyperglycemia and the association of hyperglycemia with clinical outcomes between the intervention period and a historical control period (pre-intervention at the same hospital) and a contemporaneous, non-intervention site (UAH, Edmonton) to examine whether the 'prediabetes paradox' is a result of confounding by indication or another cause.

Outcomes

If the prevalence of perioperative hyperglycemia in people with prediabetes is sufficiently high, clinical guidelines should recommend perioperative glycemic monitoring for patients with prediabetes. Further, if there is an association between hyperglycemia and adverse outcomes, intervention-based studies are needed to determine whether this risk is modifiable with hyperglycemia treatment.

Team

The NPI and co-investigators have led a 5-year implementation science and quality improvement study to improve perioperative glycemic management for people with diabetes in Alberta. This interdisciplinary group of patients, nurses, endocrinologists, surgeons, anesthesiologists, internists, and implementation scientists will leverage their existing data access, professional networks, and content expertise to conduct this study.

• Study Type: Observational
• Enrollment (Estimated): 750

Contacts and Locations

• Study Contact: Name: Shannon Ruzycki, MD; Phone Number: +1 (403) 604-1642; Email: shannon.ruzycki@ucalgary.ca

Study Locations

• Canada
  • Alberta
    • Calgary, Alberta, Canada
      • Foothills Medical Centre

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Surgical in-patients at the Foothills Medical Centre.

Description

Inclusion Criteria:

• Hemoglobin A1c measurement between 6 and 6.4%
• Scheduled for non-cardiac surgery

Exclusion Criteria:

• Age>18
• Pregnancy
• Any formal diabetes diagnosis
• Current use of medications that influence blood glucose regardless of the indication
• Undergoing cardiac, intracranial neurosurgery, bariatric, or pancreatic surgeries

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort
Surgical Patients with Prediabetes; Adult patients undergoing non-cardiac surgeries who have pre-diabetes.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Prevalence of perioperative hyperglycemia	Prediabetes will be defined as described in Section 4.2 using Diabetes Canada definitions. The perioperative period will include the day of surgery and the early postoperative period. The day of surgery includes surgical admitting, intraoperative, and recovery room on postoperative day (POD) 0, which is the day that surgery was completed until 23:59. The early postoperative period will be defined as the first 3 full postoperative days, in keeping with studies that have demonstrated that hyperglycemia is most common in the first 72 hours after surgery and that early hyperglycemia is associated with greater 30-day postoperative mortality. Hyperglycemia will be defined using Diabetes Canada reference ranges as any glucose value >10.0 mmol/L by any form of glucose measurement.	Up to the first 3 postoperative days or discharge, whichever comes first.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Post-operative complications	Postoperative complications are defined in accordance with the American College of Surgeons National Surgical Quality Improvement Program (NSQIP), a standardized list of preventable complications developed by surgeons and used internationally to describe hospital-level quality of surgical care. These include the following adverse events within 30 days of surgery: SSIs (superficial, deep incisional, organ/space, using the Centres for Disease Control definitions), wound dehiscence, pneumonia, unplanned intubation, pulmonary embolism, ventilator use >48 hours, acute renal failure, urinary tract infection, stroke, cardiac arrest, myocardial infarction, transfusion complications, deep vein thrombosis, sepsis, septic shock, Clostridium difficile infection, death, readmissions, and unplanned reoperations.	Within 30 days of surgery.

Collaborators and Investigators

• Sponsor: University of Calgary
• Investigators: Principal Investigator: Shannon Ruzycki, MD, University of Calgary

Publications and helpful links

General Publications

• Ruzycki SM, Harrison TG, Lithgow KC, Cameron A, Philp L, Heatlie L, Esmail R, Ejaredar M, Helmle K, McKeen J, Dillane D. Day-of-surgery quality gaps in glycemic management: a retrospective cohort study. Perioper Med (Lond). 2025 Nov 25;14(1):143. doi: 10.1186/s13741-025-00628-3.

Helpful Links

• This website describes the processes outlined a prior quality improvement project designed and implemented by our team. This study follows similar through lines to the present study, as we will be using the same systems and personnel.

Study record dates

Study Major Dates

• Study Start (Estimated): May 1, 2027
• Primary Completion (Estimated): May 1, 2028
• Study Completion (Estimated): May 1, 2028

Study Registration Dates

• First Submitted: February 23, 2026
• First Submitted That Met QC Criteria: June 17, 2026
• First Posted (Actual): June 23, 2026

Study Record Updates

• Last Update Posted (Actual): June 23, 2026
• Last Update Submitted That Met QC Criteria: June 17, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: Prevalence; Prediabetes; Surgical Complications; Perioperative Hyperglycemia
• Additional Relevant MeSH Terms: Endocrine System Diseases; Metabolic Diseases; Glucose Metabolism Disorders; Nutritional and Metabolic Diseases; Diabetes Mellitus; Prediabetic State
• Other Study ID Numbers: REB26-0116

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: IPD, specifically deidentified patient data will be shared upon reasonable request by fellow research teams.
• IPD Sharing Time Frame: Data will be available after analyses have completed, approximately in the month of March, 2028. Data will be retained in accordance with the University of Calgary's Master Records Retention Schedule(MaRRS). During this time period, data will be available upon reasonable request.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No