Perioperative Dexamethasone and Postoperative Hyperglycaemia in Adults with Type 2 Diabetes Undergoing Laparoscopic Cholecystectomy: A Prospective Cohort Study
Keywords:
dexamethasone, type 2 diabetes mellitus, postoperative hyperglycaemia, laparoscopic cholecystectomy, postoperative nausea and vomiting, prospective cohortAbstract
Background: Dexamethasone is used for postoperative nausea and vomiting (PONV) prophylaxis but has glycaemic effects which can make its use in patients with type 2 diabetes mellitus (T2DM) challenging. The relationship between intraoperative dexamethasone exposure and early postoperative hyperglycaemia after laparoscopic cholecystectomy was investigated in this study.
Methods: A prospective observational cohort of 386 adults (aged ≥18 years) with T2DM undergoing elective laparoscopic cholecystectomy in Tawam Hospital, Al Ain, UAE, from January 2023 to January 2025 was included. There were 193 patients in Group A (intravenous dexamethasone at induction) and 193 in Group B (no perioperative exposure to systemic corticosteroids). The glucose levels were checked before induction and at 2, 6, 12 and 24 hours after induction. The main outcome was at least one scheduled post-baseline glucose measurement >180 mg/dL. The adjusted association between dexamethasone exposure and hyperglycaemia was estimated using modified Poisson regression. Secondary endpoints were peak glucose, correction insulin, hypoglycaemia and PONV.
Results: Hyperglycaemia was seen in 72/193 patients in Group A vs 47/193 in Group B (37.3% vs 24.4% respectively and absolute difference 13.0 percentage points; 95% confidence interval [CI] 3.8–22.1). The unadjusted risk ratio (RR) was 1.53 (95% CI 1.13–2.09; Fisher’s P=0.008), and the adjusted RR was 1.33 (95% CI 1.03–1.71; P=0.028). Mean peak glucose was 174.9 ± 21.3 versus 166.1 ± 20.1 mg/dL, with an adjusted difference of 6.8 mg/dL (95% CI 4.9–8.7). Correction insulin use was similar descriptively (25.4% versus 24.9%; P=1.000). PONV occurred in 10.9% versus 21.2% (RR 0.51, 95% CI 0.31–0.83; P=0.008). A single hypoglycaemic event was recorded in Group B and neither group had a recorded glucose level >250 mg/dL.
Conclusions: There was an association between dexamethasone exposure and increased rates of above-target glucose readings, and decreased rates of PONV. The between-group glucose difference was small, and observed correction insulin use differed little. These associations support individualized assessment and glucose monitoring; they do not establish glycaemic safety equivalence or causality.
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