Patients with diabetes without hyperglycemia have a modestly increased risk of major adverse events during elective surgery, but the risk is significantly higher with hyperglycemia.

• Adjusted major adverse event rates: 5.31% (no diabetes), 5.85% (diabetes without hyperglycemia), and 9.16% (diabetes with hyperglycemia).
• The odds ratio for major adverse events was 1.13 for diabetes without hyperglycemia versus 2.00 for diabetes with hyperglycemia.

Surgeons should consider glycemic status more critically when evaluating surgical risks, as hyperglycemia signals a considerably higher perioperative risk.