Management and Outcomes of Perioperative Care of People with Diabetes across Europe (MOPED): a prospective, observational study

Abstract

Background: The prevalence of people with Diabetes Mellitus (DM) presenting for surgery is increasing. Guidelines on perioperative management are based on expert opinion with variability of practice likely. Our objective was to document perioperative management and 30-day outcomes of people with DM across Europe. Methods: This was a prospective, observational study involving 89 hospitals across 21 European countries, ranging from district general to tertiary referral centres. Between January 2021 and February 2024, 6126 people with confirmed DM (any type except gestational) receiving surgery of any kind requiring anaesthesia were followed for 30 days. Centres were self-selected by anaesthesiology clinicians working there, who enrolled consecutive people with DM to a locally determined target number. There was 5936 (97%) 30-day follow-up completion. The primary outcome was Days at Home at 30 Days (DAH-30). Secondary outcomes included descriptive characteristics of perioperative management, dysglycaemia and incidence of postoperative complications. Findings: There was significant variation between countries in perioperative DM management and 30-day outcomes, and variance in DAH-30 (median [range]) 26 [23-30] days, P = 0.0001). The proportion of people with DM with increased HbA1c (>69 mmol mol) was higher in T1DM compared with T2DM (n = 51, 18% vs n = 388, 7%; difference 11%, 95% CI 6-17; P = 0.002). In univariate analysis, there was an association between patients with lower HbA1c < 53 mmol mol-1 median (25-75% range) DAH-30 = 27 days (23-29), contrasting with higher HbA1c > 69 mmol mol, median DAH-30 = 25 days (20-28); difference 2.0, 95% CI 1.3-2.7; P < 0.0001). This association was upheld in multivariable analysis only for patients with little blood loss. Interpretation: There is a need to harmonise international practice to reduce variability in perioperative diabetes management and 30-day outcome.