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
Abstract
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…
How strong is the evidence?
Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 836 participants or records.
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