Perioperative Considerations in Patients with Type 2 Diabetes Mellitus: A Narrative Review
Consideraciones perioperatorias en el paciente con diabetes tipo 2: Revisión narrativa
DOI:
https://doi.org/10.22258/hgh.v10i3.475Abstract
Type 2 diabetes mellitus (T2DM) poses increasing perioperative challenges due to the widespread use of modern antidiabetic therapies with cardiometabolic, renal, and weight-related benefits, but also specific anesthetic and metabolic safety implications. This narrative review integrated clinical, pharmacological, and perioperative evidence on glucagon-like peptide-1 receptor agonists (GLP-1RA), dual GIP/GLP-1 agonists, and sodium-glucose cotransporter-2 inhibitors (SGLT2i). GLP-1RA and dual GIP/GLP-1 agonists are associated with delayed gastric emptying and increased residual gastric content, although their relationship with clinically significant pulmonary aspiration remains uncertain. Gastric ultrasound may support individualized risk stratification in selected settings. Conversely, SGLT2i are linked to euglycemic diabetic ketoacidosis, particularly during fasting, surgery, infection, dehydration, or carbohydrate restriction, requiring preoperative discontinuation, metabolic surveillance, and delayed reinitiation until clinical stability, euvolemia, and oral tolerance are achieved. Perioperative care in T2DM should move beyond a glucose-centered approach and incorporate medication reconciliation, multidisciplinary assessment, and individualized decision-making based on anesthetic, metabolic, and surgical risk. Keywords: Diabetes Mellitus, Type 2; Perioperative Care; Glucagon-Like Peptide-1 Receptor Agonists; Sodium-Glucose Transporter 2 Inhibitors; Diabetic Ketoacidosis (Source: MeSH, NLM).Downloads
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Copyright (c) 2026 Danuil Julián Melo-Ascanio, Lesly Giovanna Maldonado-Burbano, Juan Camilo Arias-Pérez, Valentina Bravo-Echeverry, Ivonne Lorena Reina-Fonseca, Brayan Franchesco Nocua-Martínez, Ricardo Andrés Castillo-Rojas, Antonio José Carvajal-Mazuera
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