Efficacy and safety of perioperative intravenous dexamethasone in type 2 diabetes mellitus patients undergoing total hip arthroplasty: a prospective randomized controlled trial

This study aimed to evaluate the efficacy and safety of perioperative intravenous dexamethasone (Dexa) in patients with type 2 diabetes mellitus (T2DM) undergoing total hip arthroplasty (THA). In this prospective, single-blind randomized trial (Registration No.: MR-45-23-047982; Registration Date: December 7, 2023), 60 T2DM patients undergoing THA were assigned to either the Dexa or control group. Outcomes included white blood cell count (WBC), C-reactive protein (CRP), visual analogue scale (VAS) scores, blood glucose, nausea and vomiting, medication requirements, complications, and hospital stay. Compared with controls, the Dexa group had lower WBC on postoperative days 2 ~ 3 (day 2: 9.20 ± 1.28 vs.10.56 ± 2.34 × 109/L, P = 0.007; day 3: 8.02 ± 1.34 vs. 9.22 ± 1.49 × 109/L, P = 0.002)and reduced CRP on days 1 ~ 3 (day 1: 38.20 vs. 63.50 mg/L, P = 0.040; day 2: 86.00 vs. 101.50 mg/L, P = 0.010; day 3: 78.00 vs. 95.20 mg/L, P = 0.044). Transient hyperglycemia was observed in the Dexa group on postoperative day 1, with higher median blood glucose (8.90 vs. 8.35 mmol/L, P < 0.01) and peak glucose (11.80 vs. 10.35 mmol/L, P = 0.031) but showed no differences thereafter. VAS pain scores at rest and during activity were lower in the Dexa group on postoperative days 1 ~ 2 (all P < 0.01). Dexa reduced the need for rescue tramadol (4 vs. 12 patients, P = 0.020) and metoclopramide (1 vs. 8 patients, P = 0.026), and lowered PONV incidence (3.33% vs. 23.30%, P = 0.026). Hospital stay was shorter in the Dexa group (5.67 ± 1.13 vs. 6.70 ± 1.29 days, P = 0.002), with no differences in 90-day complications (all P > 0.05). Perioperative Dexa administration improves early recovery outcomes in patients with T2DM undergoing THA without compromising short-term safety, although it may cause transient hyperglycemia. However, the relatively small sample size, limited follow-up period, and lack of systematic evaluation of potential complications highlight the need for larger, longer-term studies to further strengthen these observations.