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Anesthesia and analgesia · Oct 2018
Randomized Controlled TrialPreoperative Continuation Versus Interruption of Oral Hypoglycemics in Type 2 Diabetic Patients Undergoing Ambulatory Surgery: A Randomized Controlled Trial.
It’s likely safe to continue metformin and sulphonylureas in those fasting for day surgery, in the absence of renal impairment.
pearl- Irina Gasanova, Jin Meng, Abu Minhajuddin, Emily Melikman, John C Alexander, and Girish P Joshi.
- From the Departments of Anesthesiology and Pain Management.
- Anesth. Analg. 2018 Oct 1; 127 (4): e54-e56.
AbstractPatients with type 2 diabetes mellitus receiving oral hypoglycemic drugs (OHDs) are usually instructed to stop them before surgery. We hypothesize that continuing OHD preoperatively should result in lower perioperative blood glucose (BG) levels. Ambulatory surgery patients with type 2 diabetes mellitus on OHDs were randomized to continue (n = 69) or withhold (n = 73) OHDs preoperatively. Log-transformed BG levels at pre-, intra-, and postoperative periods were analyzed. Perioperative BG levels were significantly lower (mean, 138 mg/dL; 95% confidence interval, 130-146 mg/dL) in the group that continued versus the group that discontinued OHDs (mean, 156 mg/dL; 95% confidence interval, 146-167 mg/dL; P < .001).
Notes
Why is this important?
6% of the world's population has diabetes mellitus, making it one of the most common perioperative comorbidities. Withholding oral-hypoglycaemics pre-op is common, but worsens glucose control and so may increase post-op complications.
What did they find?
Ambulatory patients who had their metformin and/or sulphonylurea OHG agents continued perioperatively had better glucose control.
Be cautious as this was a relatively small study, and not adequately powered to compare hypoglycaemia rates or (ridiculously) rare complications such as lactic acidosis. Additionally, no investigation was made of post-op complications, instead using glucose control as a surrogate outcome.
Bottom line
It's probably safe and beneficial to continue metformin and sulphonylureas perioperatively in those having ambulatory day-surgery with normal renal function.
Daniel Jolley
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