Withholding or continuing glucose-lowering drugs for elective surgery in patients with type 2 diabetes mellitus: a secondary analysis of the MOPED international, prospective, observational study
British Journal of Anaesthesia, cilt.137, sa.1, ss.99-109, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 137 Sayı: 1
- Basım Tarihi: 2026
- Doi Numarası: 10.1016/j.bja.2026.03.068
- Dergi Adı: British Journal of Anaesthesia
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, CINAHL, EMBASE, MEDLINE, Academic Search Ultimate (EBSCO), Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest), Pharma Collection (ProQuest)
- Sayfa Sayıları: ss.99-109
- Anahtar Kelimeler: diabetes mellitus, general anaesthesia, glucose lowering drugs, insulin, postoperative complications, regional anaesthesia
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Background: There are conflicting guidelines on whether patients with type 2 diabetes mellitus should withhold or continue glucose-lowering drugs before surgery, especially newer agents. We tested the hypothesis that continuing glucose-lowering drugs increases days alive at home and out of hospital at 30 days (DAH-30). Methods: We performed a secondary analysis of a prospective, observational study in 21 European countries of patients with type 2 diabetes mellitus undergoing elective surgery. The primary outcome was DAH-30. The exposure of interest was the continuation or discontinuation of glucose-lowering drugs (metformin, sodium-glucose cotransporter 2 inhibitors [SGLT2i], glucagon-like peptide-1 receptor agonists [GLP-1 RA]). Median (interquartile [IQR]) values are shown. Results: Between January 2021 and December 2024, 5767 participants with type 2 diabetes mellitus (age 64 [range: 22–89] yr; 43% female) were enrolled from 89 centres, with 4988 (87%) undergoing elective surgery. For 3623/5767 (73%) participants receiving metformin, DAH-30 was higher (28 days [24–29]) in 421/3623 (12%) participants who continued metformin on the day of surgery compared with 27 days (23–29) in 3202 of 5767 (88%) participants who had not taken metformin (P=0.001). After adjusting for prespecified covariates, continuing metformin on the day of surgery remained associated with higher DAH-30 (0.47 days [95% confidence interval:0.01–0.93]; P=0.044). No association was found for either stopping/continuing SGLT2i (n=836 participants) or GLP-1 RA (n=304 participants) with DAH-30. Conclusions: Continuing metformin during surgery among patients with type 2 diabetes mellitus was associated with marginally shorter DAH-30, but the sample size for participants receiving SGLT2i and GLP-1 RA therapy precluded any meaningful estimates. Tracker ID: ESA-IC_CTN_MOPED.