Perioperative Digital Glycaemic Management in Gastrointestinal Surgery

BACKGROUND: Perioperative dysglycemia in gastrointestinal surgery is driven by fasting, surgical stress, inflammation, medications, nutritional transitions, and enhanced recovery pathways. Conventional glycaemic management based on intermittent testing and reactive insulin adjustment may not adequately capture these rapid metabolic changes. METHODS: Recent guidelines, expert consensus statements, randomized trials, systematic reviews, and implementation studies addressing perioperative digital glycaemic management were narratively reviewed. RESULTS: Perioperative digital glycaemic management can be conceptualised as a workflow-integrated control loop that encompasses glucose sensing, contextual clinical data analysis, algorithm-assisted interpretation, insulin-nutrition coordination, and multidisciplinary governance. Emerging technologies, including continuous glucose monitoring (CGM), electronic health record (EHR)-based alerts, and closed-loop insulin systems, may improve the continuity and responsiveness of perioperative metabolic care. CONCLUSIONS: Digital glycaemic pathways offer a more adaptive approach to perioperative management in gastrointestinal surgery. Future studies should determine whether these strategies improve clinically meaningful surgical outcomes beyond glucose metrics alone.