Perioperative anesthesia care for patients with diabetes mellitus: a review of current literature with focus on oral antidiabetic medication

Every fifth surgical patient presents with diabetes mellitus.

• The 2025 international guidelines recommend continuing glucagon-like peptide-1 receptor agonists in patients without a high risk of aspiration.
• Sodium-glucose co-transporter-2 inhibitors may need to be temporarily discontinued one to four days before surgery.
• Specific recommendations for dipeptidyl peptidase-4 inhibitors are not provided in the guidelines.
• Large cohort studies show very low incidences of pulmonary aspiration and euglycemic ketoacidosis in patients using these medications.
• Adverse events associated with oral antidiabetic agents have mostly been documented in case reports rather than large studies.

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