1887
Volume 2025, Issue 1
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Diabetes mellitus (DM) is a prevalent condition that requires careful management in the perioperative setting to reduce surgical risks and optimize patient outcomes. The preoperative care of diabetic patients is complex because glucose control must be balanced with minimizing hypoglycemic or hyperglycemic events during surgery. A variety of diabetic medications such as insulin, dipeptidyl-peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists, sodium–glucose cotransporter-2 inhibitors, and biguanides such as metformin present unique challenges and considerations due to their different mechanisms, benefits, and potential adverse effects. In recent years, professional organizations have developed recommendations on the perioperative management of these therapies, although there remain some variations in guidelines related to medication cessation and dosage adjustments. Standardized protocols in preoperative DM care remain a topic of interest to ensure consistent and safe practices across healthcare settings, and further collaborative research efforts could provide clarity and consensus in managing this diverse patient population.

The objective of this study was to provide an overview of guidelines and practices to support healthcare professionals in delivering improved preoperative care for diabetic patients. This initiative aims to enhance surgical outcomes and minimize the occurrence of complications.

This is a comparative review that provides a systematic comparison of the similarities and differences in the guidelines and recommendations of three professional organizations along with Hamad Medical Corporation. All guidelines were from official websites including Hamad Medical Corporation.

Although the reviewed guidelines for the preoperative care of diabetes patients share some similarities, there are also a number of differences due to outdated data and expert opinions, and therefore differ in practices around the world. While the key elements are agreed upon, more research and global collaboration are needed to create consistent guidelines and improve patient outcomes.

Loading

Article metrics loading...

/content/journals/10.5339/qmj.2025.23
2025-03-17
2025-04-02
The full text of this item is not currently available.

References

  1. Preiser JC, Provenzano B, Mongkolpun W, Halenarova K, Cnop M. Perioperative management of oral glucose-lowering drugs in the patient with type 2 diabetes. Anesthesiology. 2020; 133:(2):430–438. doi: 10.1097/aln.0000000000003237.
    [Google Scholar]
  2. Crowley K, Scanaill PO, Hermanides J, Buggy DJ. Current practice in the perioperative management of patients with diabetes mellitus: a narrative review. British Journal of Anaesthesia. 2023; 131:(2):242–252. doi: 10.1016/j.bja.2023.02.039.
    [Google Scholar]
  3. Awad SF, Toumi AA, Al-Mutawaa KA, Alyafei SA, Ijaz MA, Khalifa SAH, et al. Type 2 diabetes epidemic and key risk factors in Qatar: a mathematical modeling analysis. BMJ Open Diabetes Res Care. 2022 Apr 20; 10:(2)e002704. doi: 10.1136/bmjdrc-2021-002704.
    [Google Scholar]
  4. Palermo NE, Garg R. Perioperative management of diabetes mellitus: novel approaches. Current Diabetes Reports. Curr Diab Rep. 2019 Feb 26; 19:(4)14. doi: 10.1007/s11892-019-1132-7.
    [Google Scholar]
  5. Garg R, Grover A, McGurk S, Rawn JD. Predictors of hyperglycemia after cardiac surgery in nondiabetic patients. J Thorac Cardiovasc Surg. 2013 Apr; 145:(4):1083–1087. doi: 10.1016/j.jtcvs.2012.07.089.
    [Google Scholar]
  6. Sapra A, Bhandari P. Diabetes. StatPearls [online]. 2023 Jun 21. Treasure Island, FL: StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551501/.
    [Google Scholar]
  7. American Diabete. Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010 Jan 1; 33:(Suppl 1):S62–S69. doi: 10.2337/dc10-S062.
    [Google Scholar]
  8. Thota S, Akbar A. Insulin. StatPearls [online]. Treasure Island, FL: StatPearls Publishing. 2023 July 10. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560688/.
    [Google Scholar]
  9. Mishra V, Nayak P, Sharma M, Albutti A, Alwashmi ASS, Aljasir MA, et al. Emerging treatment strategies for diabetes mellitus and associated complications: an update. Pharmaceutics. 2021 Sep 27; 13:(10)1568. doi: 10.3390/pharmaceutics13101568.
    [Google Scholar]
  10. Corcoran C, Jacobs TF. Metformin. StatPearls [online]. Treasure Island, FL: StatPearls Publishing. 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK518983/.
    [Google Scholar]
  11. ANZCA Perioperative Diabetes Working Party ANZCA. ADS-ANZCA Perioperative Diabetes and Hyperglycaemia Guidelines (Adults) [online]. Sydney, Australia: Australian Diabetes Society; 2023. Available from: https://www.diabetessociety.com.au/wp-content/uploads/2023/03/ADS-ANZCA-Perioperative-Diabetes-and-Hyperglycaemia-Guidelines-Adults-November-2022-v2-Final.pdf .
  12. Costello RA, Nicolas S, Shivkumar A. Sulfonylureas. StatPearls [online]. Treasure Island, FL: StatPearls Publishing. 2023 Jul 12. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513225/.
    [Google Scholar]
  13. Eggleton JS, Jialal I. Thiazolidinediones. StatPearls [online]. Treasure Island, FL: StatPearls Publishing. 2023 Feb 20. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551656/.
    [Google Scholar]
  14. Collins L, Costello RA. Glucagon-like peptide-1 receptor agonists. StatPearls [online]. Treasure Island, FL: StatPearls Publishing. 2023 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551568/.
    [Google Scholar]
  15. Klein SR, Hobai IA. Semaglutide, delayed gastric emptying, and intraoperative pulmonary aspiration: a case report. Can J Anesth. 2023 Aug 1; 70:(8)1394–1396. doi: 10.1007/s12630-023-02440-3.
    [Google Scholar]
  16. Seki H, Ideno S, Shiga T, Watanabe H, Ono M, Motoyasu A, et al. Sodium-glucose cotransporter 2 inhibitor-associated perioperative ketoacidosis: a systematic review of case reports. J Anesth. 2023 Jun; 37:(3)465–473. doi: 10.1007/s00540-023-03174-8.
    [Google Scholar]
  17. Clinical Protocol Title: Management of Diabetic Patients Going for Surgery and Procedure, Identification number – CPRO 10567. Hamad Medical Corporation – 2024.
  18. Nathanson MH, Dhatariya K. Correction to Perioperative management of the surgical patient with diabetes 2015: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia. 2019 April; 74:(6)810. doi: 10.1111/anae.14663.
    [Google Scholar]
  19. ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, et al. 16. Diabetes care in the hospital: standards of care in diabetes—2023. Diabetes Care. 2022 Dec 12; 46:(Suppl 1):S267–S278. doi: 10.2337/dc23-S016.
    [Google Scholar]
  20. Association of Anaesthetists of Great Britain and Ireland. Peri-operative management of the surgical patient with diabetes 2015. Anaesthesia [online]. 2015 Dec; 70:(12)1427–1440. Available from: https://onlinelibrary.wiley.com/doi/10.1111/anae.13233/full .
  21. Marroquin-Harris M, Olesnicky B. Aspiration risk with glucagon-like peptide 1 (GLP-1) agonists. Anaesthesia. 2023 Dec; 78:(12):1524. doi: 10.1111/anae.16099.
    [Google Scholar]
/content/journals/10.5339/qmj.2025.23
Loading
/content/journals/10.5339/qmj.2025.23
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error