Donal J. Buggy, Donal J. Buggy, Malachy O. Columb, Jeroen Hermanides, M W Hollmann, Mark Coburn, Alexander Zarbock, Angel Caballero, Peter Paal, Sanja Granov, Marijana Rehorić Krkusek, Gianluca Samarani, Tamar Macharadze, Christoph Sponholz, Eleni Arnaoutoglou, Pádraig Ó. Scanaill, Orit Nahtomi Shick, Matteo Bossolasco, Jasmina Ilievska, Jeroen Hermanides, Katarzyna Kotfis, Andreia Capelão, Daniela Ionescu, Sergey Efremov, Pavel Dunts, Unic Stojanovic, Marina Soro, Kemal Tolga Saracoglu, Simon Howell, Paul Köglberger, Gabriel Putzer, Barbara Ebner, Martin Grünbart, Hannes Hoi, Simone Santosuosso, Senada Čaušević, Mirza Kovačević, Asmira Ljuca, Sanja Granov, Ilirijana Haxhibeqiri‐Karabdic, Slavenka Štraus, Sanja Berić, Ana Jurin Martić, Ana Horvat, Helena Krolo Videka, Emil Dolenc, Jasminka Peršec, Marko Pražetina, Nikola Ivanov, Nataša Paklar, Gianluca Samarani, G Grigolia, Tsotne Samadashvili, Lasha Tabagari, Gvantsa Kachlishvili, Gabriel Janashvili, Johannes Roth, Oliver Sommerfeld, Christoph Sponholz, Lars Bergmann, Sebastian Schmid, Achilles Delis, Marie-Louise Fingerhut, Tobias Hilbert, Gregor Massoth, Claudia Neumann, Mária Wittmann, Christian Koch, Maria Theresa Vöelker, Konstantinos Stroumpoulis, Georgia Micha, Georgia Tsaousi, Eleni Arnaoutoglou, Maria Ntalouka, Dimitra Papaspyrou, Styliani Apostolaki, Elissavet Anestiadou, Orestis Ioannidis, Konstantinos Zapsalis, Louise Moran, Ahmed Abdelaatti, Mushtaq Ahmad, Donal Buggy, Donal Buggy, Pádraig Ó. Scanaill, John Shaker, Junaid Hashmi, Kristiana Nali, Andrea Haren, Sophie Shinnors, Donal Rafferty, Kim Caulfield, Darren McMahon, Yaacov Gozal, Ra'ed Ishaq Jebrin, Waseem Moharib, Orit Nahtomi Shick, Andrea Barranco, Paola Aceto, Ersilia Luca
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.