2971-LB: Impact of Early Insulin Response and Steroid Use on Postoperative Hyperglycemia

Introduction and Objective: Preoperative identification of patients at risk for postoperative stress hyperglycemia (SH) is challenging, as routine testing misses dysglycemia. We used oral glucose tolerance testing (OGTT) and CGM to identify predictors of SH and clinically relevant interactions. Methods: High-risk patients (age ≥45, BMI ≥28 kg/m²) without known diabetes undergoing non-cardiac surgery had preoperative 6-point OGTT, HbA1c, and blinded CGM. SH was defined as sensor glucose >140 mg/dL and dysglycemia by ADA criteria. Firth logistic regression was used to identify key predictors derived from OGTT and CGM, including insulin resistance and secretion indices. Interactions were explored in a reduced model and used to identify predictors of SH. Results: Among 57 participants (age 58.1±7.1 years), 67% had preoperative dysglycemia, and 67% developed SH. Preoperative steroid use and early insulin response (corrected insulin response at 30 min, CIR_30) emerged as key predictors. The prediction grid (Figure) illustrates a higher probability of SH with lower CIR_30. Steroid use further increased this risk, especially in those without pre-existing dysglycemia and lower CIR_30. Conclusion: Early insulin secretion deficiency may be an important predictor of SH, particularly in the context of perioperative steroid exposure and among patients without underlying dysglycemia, underscoring the need for practical risk stratification and careful steroid management. Disclosure O. Oladejo: None. L. Chadalawada: None. L. Peng: None. F.J. Pasquel: Research Support; Current; Dexcom, Inc., Insulet Corporation, Ideal Medical Technologies. Research Support; Ended; Novo Nordisk, Tandem Diabetes Care, Inc. Consultant; Ended; Insulet Corporation. G.M. Davis: Research Support; Current; Insulet Corporation, Sequel Med Tech. Funding NIH, NIDDK