Perioperative and Glycemic Control in General Surgery

Dear Colleagues,

Glycemic control in the perioperative setting represents one of the most clinically relevant and underexplored frontiers in modern general surgery. Dysglycemia—encompassing both hyperglycemia and hypoglycemia—is independently associated with increased surgical site infections, anastomotic complications, prolonged hospital stay, and higher 30-day mortality. Despite mounting evidence, current perioperative glycemic management remains largely fragmented, with substantial heterogeneity in protocols across institutions, surgical specialties, and patient populations. The urgency to standardize and innovate in this field has never been greater.

The rapid evolution of diabetes pharmacology—from GLP-1 receptor agonists and dual GIP/GLP-1 agonists to SGLT-2 inhibitors and ultra-long-acting insulin analogues—has dramatically changed the metabolic landscape of surgical patients, generating new challenges in preoperative optimization, intraoperative management, and postoperative recovery. Simultaneously, continuous glucose monitoring (CGM) and flash glucose monitoring technologies are beginning to find application in the perioperative context, offering real-time data streams that could fundamentally transform how we prevent and detect hypoglycemia—historically the most feared and underreported complication of tight glycemic control. These advances, combined with the growing adoption of enhanced recovery after surgery (ERAS) pathways, create a transformative opportunity to redefine perioperative glycemic strategies around patient safety, metabolic resilience, and quality of life outcomes.

This Special Issue aims to present and disseminate the most recent advances related to perioperative glycemic management in general surgery patients. We consider contributions addressing the full spectrum of perioperative care—from preoperative metabolic optimization to intraoperative glucose regulation and postoperative metabolic recovery—with a particular focus on hypoglycemia prevention, patient-reported quality of life, novel pharmacological agents, emerging monitoring technologies, and the integration of glycemic protocols within ERAS frameworks. Original research articles and comprehensive review papers are all welcome.

Topics of interest for publication include, but are not limited to, the following:

• The impact of perioperative glycemic dysregulation on short- and long-term surgical outcomes;
• Hypoglycemia prevention strategies in surgical and critically ill patients;
• Continuous glucose monitoring (CGM) and flash glucose monitoring in perioperative settings;
• Novel pharmacological agents (GLP-1 receptor agonists, SGLT-2 inhibitors, and tirzepatide) and perioperative management protocols;
• Insulin therapy optimization and closed-loop systems in the operative context;
• ERAS protocols and glycemic control: integration, outcomes, and gaps;
• Preoperative carbohydrate loading and its metabolic implications;
• Glycemic control in oncological surgery: specific considerations and outcomes;
• Patient-reported outcomes and quality of life related to perioperative glycemic management;
• Metabolic surgery and its impact on glycemic control beyond bariatrics;
• Artificial intelligence and predictive modeling for perioperative glucose management;
• Glycemic control in emergency surgery and damage control scenarios;
• Nutritional support and glycemic balance in the perioperative window;
• Sex- and age-related differences in perioperative metabolic response.

Dr. Baudolino Mussa
Guest Editor

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

• perioperative glycemic control
• hypoglycemia prevention
• continuous glucose monitoring
• ERAS
• GLP-1 receptor agonists
• SGLT-2 inhibitors
• surgical stress response
• insulin therapy
• patient quality of life
• metabolic surgery