Journal Article Ahead of print 2 citations
PubMed: 42303515 DOI: 10.1016/j.bja.2026.05.009
The effect of intraoperative dexamethasone on glycaemic responses in people with diabetes mellitus: a preplanned analysis of the Perioperative ADministration of Dexamethasone and Infection trial.
Br J Anaesth
Authors: Leon A Bach, Catherine Martin, Richard J MacIsaac, Paul S Myles, Mohammad Asghari-Jafarabadi, Edmond O'Loughlin, David Story, Kwok Ho, Jaspreet Sidhu, Tomas B Corcoran
Affiliations
- Department of Endocrinology and Diabetes, The Alfred, Melbourne, Australia; School of Translational Medicine, Monash University, Melbourne, Australia.
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Australia; Department of Medicine, St Vincent's Hospital Melbourne and University of Melbourne, Fitzroy, Australia; Australian Centre for Accelerating Diabetes Innovations, School of Medicine, University of Melbourne, Parkville, Australia.
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Australia.
- Biostatistics Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Psychiatry, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia; Cabrini Research, Cabrini Health, Malvern, Australia.
- Department of Anaesthesia, Pain and Perioperative Medicine, Fiona Stanley Hospital, Murdoch, Australia.
- Department of Critical Care, University of Melbourne, Parkville, Australia.
- Department of Anaesthesia and Intensive Care, Prince of Wales Hospital and The Chinese University of Hong Kong, Hong Kong SAR, China.
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Australia; School of Medicine and Pharmacology University of Western Australia, Perth, Australia.
Abstract
BACKGROUND
The Perioperative ADministration of Dexamethasone and Infection (PADDI) randomised placebo-controlled trial showed that a single 8 mg dose of intraoperative dexamethasone had no effect on surgical-site infection within 30 days after nonurgent, noncardiac surgery. Whether dexamethasone increases blood glucose and adverse outcomes in people with diabetes mellitus remains unclear.
METHODS
In this preplanned sub-study, 1130 PADDI participants (mean age 65.2 years: 40.7% female) with diabetes mellitus and glycated haemoglobin <9.0% were included in this 'as treated' analysis. The primary outcome was the maximum recorded perioperative blood glucose concentration (mM) within 24 h of anaesthesia induction.
RESULTS
The maximum perioperative blood glucose level was 12.5 mM (median, IQR 10.6-15.0) in 570 participants receiving dexamethasone, compared with 10.3 mM (8.8-12.4) in 560 participants receiving placebo (estimated difference 1.86 mM (95% CI 1.50-2.22), P<0.001). There was no evidence of increased risk of surgical-site infection (dexamethasone 11.1% vs placebo 14.4%, risk ratio [RR], 0.74; 95% confidence interval [CI], 0.54-1.01). Age, sex, BMI and HbA1c were not associated with maximum perioperative glucose levels or the incidence of surgical-site infections between the dexamethasone and placebo groups. The requirement for additional insulin and the number of hypoglycaemic episodes did not differ between groups.
CONCLUSION
In people with diabetes mellitus, dexamethasone was associated with a modest increase in perioperative blood glucose but not with increased surgical-site infection. These findings support the use of dexamethasone to prevent postoperative nausea and vomiting in people with diabetes mellitus.
MeSH
Diabetes Mellitus, Anesthesia, Blood Glucose, Blood, Anesthesiology, Dexamethasone, Surgical Wound Infection, Infections