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

Buggy, D.J.; Columb, M.O.; Hermanides, J.; Hollmann, M.W.; Coburn, M.; Zarbock, A.; Moped Investigators: Angel Caballero,; Paal, P.; Granov, S.; Marijana Rehorić Krkušek,; Samarani, G.; Macharadze, T.; Sponholz, C.; Arnaoutoglou, E.; Pádraig, Ó.S.; Orit Nahtomi Shick,; Bossolasco, M.; Ilievska, J.; Hermanides, J.; Kotfis, K.; Capelão, A.; Ionescu, D.; Efremov, S.; Dunts, P.; Stojanovic, U.; Soro, M.; Kemal Tolga Saracoglu,; Howell, S.; Köglberger, P.; Putzer, G.; Ebner, B.; Grünbart, M.; Hoi, H.; Santosuosso, S.; Causevic, S.; Kovacevic, M.; Ljuca, A.; Granov, S.; Haxhibeqiri-Karabdic, I.; Straus, S.; Berić, S.; Ana Jurin Martić,; Horvat, A.; Helena Krolo Videka,; Dolenc, E.; Peršec, J.; Pražetina, M.; Ivanov, N.; Paklar, N.; Samarani, G.; Grigolia, G.; Samadashvili, T.; Tabagari, L.; Kachlishvili, G.; Janashvili, G.; Roth, J.; Sommerfeld, O.; Sponholz, C.; Bergmann, L.; Schmid, S.; Delis, A.; Fingerhut, M.; Hilbert, T.; Massoth, G.; Neumann, C.; Wittmann, M.; Koch, C.; Maria Theresa Voelker,; Stroumpoulis, K.; Micha, G.; Tsaousi, G.; Arnaoutoglou, E.; Ntalouka, M.; Papaspyrou, D.; Apostolaki, S.; Anestiadou, E.; Ioannidis, O.; Zapsalis, K.; Moran, L.; Abdelaatti, A.; Ahmad, M.; Buggy, D.; Pádraig, Ó.S.; Shaker, J.; Hashmi, J.; Nali, K.; Haren, A.; Shinnors, S.; Rafferty, D.; Caulfield, K.; Mcmahon, D.; Gozal, Y.; Ra'Ed Ishaq Jebrin,; Moharib, W.; Orit Nahtomi Shick,; Barranco, A.; Aceto, P.; Luca, E.; Cortegiani, A.; Fiorelli, S.; Menna, C.; Tiracorrendo, M.; Cotoia, A.; Marra, A.; Bellini, V.; Bignami, E.; Domaneschi, C.; Ilievska, J.; Abraham, H.H.; Hermanides, J.; Lars Ip Snel,; Eelko, K.D.G.; Robert Wilpe Van,; Holtrust, Y.; Janssen, L.; Caris, E.; Koopman, S.; Oversier, N.; Postema, J.; Rapon, J.; Wouter Van Bockel,; Samuel Haig Barclay,; Marc Bernard Godfried,; Czarnik, T.; Uchacz, A.; Kusza, K.; Arciszewski, M.; Kotfis, K.; Pankowiak, M.; Pawłowicz, B.; Reszka, E.; Zajac, J.; Baptista, S.; Pinto, R.; Andrez, S.; Azevedo, J.; Cardoso, J.; Carina, M.; Elsa, R.; Jones, J.; Fernando José Abelha,; Lopes, A.; Mourão, J.; Pereira, L.; Santos, A.; Florin Teodor Bobirca,; Tomescu, D.; Sargarovschi, S.; Sima, R.; Efremova, N.; Ovezov, A.; Hussain, A.; Dzhumatov, T.; Efremov, S.; Jumatava, Y.; Skvortsov, V.; Trofimov, A.; Unic-Stojanovic, D.; Soro, M.; José Maria Cubero-Marcos,; Gisela Myrella Hermenegildo Chávez,; Hinojal-Blanco, I.; Martínez-Díaz, A.; Romero-González, M.; Urrútia, G.; Becerra-Bolaños, Á.; Trujillo-Morales, H.; Olga de la Varga-Martínez,; Gómez-Aguilar, P.; Nieto-Moreno, A.; Dogan, L.; Dilek Ömür Arça,; Ayşe Zeynep Turan Civraz,; Yurt, E.; Karasu, D.; Tayfun, E.; Gaye Boztepe Yilmaz,; Ekinci, O.; Kurup, D.; Barton, S.; Wilson, T.; Thomas, C.; Day, J.; Hormis, A.; Patel, D.; Waugh, V.; Srinivasaiah, R.; Gautam, N.; Miltsios, K.; Daamen, S.; Harlet, P.; Farsi, S.; Saman Homayun Sepehr,; Debouche, S.; Maxim Van Belle,

doi:10.1016/j.bja.2026.03.068

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.

Donal J, B., Malachy O, C., Jeroen, H., Markus W, H., Mark, C., Alexander, Z., et al. (2026). 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 [10.1016/j.bja.2026.03.068].