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.

Abstract

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. 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. 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. 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.