Presentation Details
| Effect of a Preoperative Clear Liquid Diet on Glucose Levels on Day of Surgery in Diabetic Patients Continuing Glucagon-like Peptide-1 Receptor Agonists Isabel Lammers, Kristy A Kenter, Mark Kachai, Heike C Knorpp. University of Illinois Hospital & Health Sciences System (UI Health), Chicago, IL, USA |
Abstract
BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1RA) are increasingly used to manage diabetes; however, they increase the risk of perioperative aspiration. In response to recent literature, our institution has implemented recommendations to continue GLP-1RA with a clear liquid diet (CLD) preoperatively. We sought to determine the impact of this intervention on day of surgery (DOS) glucose levels in diabetic patients, in comparison to our previous process of simply holding GLP-1RA.
METHODS: We retrospectively reviewed DOS preoperative point-of-care glucose in 950 adult diabetic patients on GLP-1RA undergoing elective surgery at the University of Illinois Hospital & Health Sciences System before (January-May 2025) and after implementation of preoperative CLD (July-September 2025). In the early group (607 patients), GLP-1RAs were held for one week before surgery. In the CLD group (343 patients), GLP-1RAs were continued. Patients began CLD at 7 AM the day before surgery. In the CLD group, insulin was reduced to 80% of the long-acting dose and 50% of the intermediate-acting or premixed dose for two doses prior to surgery; glipizide was held day-before and DOS. Standard preoperative medication instructions for diabetes medications were otherwise unchanged between groups. DOS preoperative glucose was compared between the two groups.
RESULTS: Distribution of glucose values is shown in Figure 1. Statistical analysis demonstrated a small but significant improvement in DOS glucose levels in the CLD/GLP-1RA continuation group. Mean glucose decreased from 137.8 mg/dL pre-implementation to 127.6 mg/dL post-implementation of the CLD. Median glucose decreased from 122 mg/dL (IQR ±57.0) pre-implementation to 117 mg/dL (IQR ±49.5) post-implementation. Both the Mann-Whitney U test (p = 0.0039) and Welch’s t-test (p = 0.0021) demonstrated statistically significant differences with p-values below 0.05 (Figure 2).
CONCLUSIONS: These findings support safe use of preoperative CLD protocols in diabetic patients continuing GLP-1RAs.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
METHODS: We retrospectively reviewed DOS preoperative point-of-care glucose in 950 adult diabetic patients on GLP-1RA undergoing elective surgery at the University of Illinois Hospital & Health Sciences System before (January-May 2025) and after implementation of preoperative CLD (July-September 2025). In the early group (607 patients), GLP-1RAs were held for one week before surgery. In the CLD group (343 patients), GLP-1RAs were continued. Patients began CLD at 7 AM the day before surgery. In the CLD group, insulin was reduced to 80% of the long-acting dose and 50% of the intermediate-acting or premixed dose for two doses prior to surgery; glipizide was held day-before and DOS. Standard preoperative medication instructions for diabetes medications were otherwise unchanged between groups. DOS preoperative glucose was compared between the two groups.
RESULTS: Distribution of glucose values is shown in Figure 1. Statistical analysis demonstrated a small but significant improvement in DOS glucose levels in the CLD/GLP-1RA continuation group. Mean glucose decreased from 137.8 mg/dL pre-implementation to 127.6 mg/dL post-implementation of the CLD. Median glucose decreased from 122 mg/dL (IQR ±57.0) pre-implementation to 117 mg/dL (IQR ±49.5) post-implementation. Both the Mann-Whitney U test (p = 0.0039) and Welch’s t-test (p = 0.0021) demonstrated statistically significant differences with p-values below 0.05 (Figure 2).
CONCLUSIONS: These findings support safe use of preoperative CLD protocols in diabetic patients continuing GLP-1RAs.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
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