Key result
Intra-operative dexamethasone (4 mg or 8 mg) did not induce greater hyperglycaemia compared with placebo in nondiabetic and well-controlled diabetic patients undergoing noncardiac surgery.
Why the study?
The hyperglycaemic effect of dexamethasone in diabetic and nondiabetic patients during the perioperative period was unknown.
Does intravenous dexamethasone increase maximum blood glucose within 24 hours in adults undergoing elective non-cardiac surgery?
RCT (n=302)
stratified
Yes
Does intravenous dexamethasone increase maximum blood glucose within 24 hours in adults undergoing elective non-cardiac surgery?
Intravenous dexamethasone (4 mg or 8 mg) does not induce greater hyperglycemia compared with placebo in nondiabetic and well-controlled diabetic patients, but higher baseline HbA1c predicts significant hyperglycemia with 8 mg dexamethasone.
Permits intraoperative dexamethasone without glycaemic concern in nondiabetic and well-controlled diabetic noncardiac surgery patients; confirms neutral glucose effect versus placebo.
BACKGROUND: The hyperglycaemic effect of dexamethasone in diabetic and nondiabetic patients in the peri-operative period is unknown. OBJECTIVE: To assess the effect of a single dose of intra-operative dexamethasone on peri-operative blood glucose. DESIGN: Multicentre, stratified, randomised trial. SETTING: University hospitals in Australia and Hong Kong. PATIENTS: A total of 302 adults scheduled for elective, noncardiac and nonobstetric surgical procedures under general anaesthesia, stratified by diabetes mellitus status, were randomised to receive placebo, 4 or 8 mg dexamethasone administered intravenously after induction of anaesthesia. MAIN OUTCOME MEASURES: Maximum blood glucose within 24 h of surgery, and the interaction between glycated haemoglobin (HbA1c) and dexamethasone were the primary and secondary outcomes. RESULTS: The median [IQR] baseline blood glucose in the nondiabetes stratum in the placebo (n=81), 4 mg (n=81) and 8 mg dexamethasone (n=77) trial arms were respectively 5.3 [4.6 to 5.8], 5.0 [4.7 to 5.4] and 5.0 [4.2 to 5.9] mmol l-1. In the diabetes stratum these values were 6.6 [6.0 to 8.3]; (n=22), 6.1 [5.5 to 10.4]; (n=22) and 6.7 [5.6 to 8.3]; (n=19) mmol l-1. The median [IQR] maximum peri-operative blood glucose values in the nondiabetes stratum were 6.0 [5.3 to 6.8], 6.3 [5.5 to 7.3] and 6.3 [5.8 to 7.4] mmol l-1 in the control, dexamethasone 4 mg and dexamethasone 8 mg arms, respectively. In the diabetes stratum these values were 10.3 [8.1 to 12.4], 12.6 [10.3 to 18.3] and 13.6 [11.2 to 20.1] mmol l-1. There was a significant interaction between pre-operative HbA1c value and 8 mg dexamethasone: every 1% increment in HbA1c produced a 4.0 mmol l-1 elevation in maximal peri-operative glucose concentration. CONCLUSION: Dexamethasone 4 mg or 8 mg did not induce greater hyperglycaemia compared with placebo for nondiabetic and well controlled diabetic patients. Maximal peri-operative blood glucose concentrations in patients with diabetes were related to baseline HbA1c values in a concentration-dependent fashion after 8 mg of dexamethasone. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Registry (ACTRN12614001145695): URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367272.
No takes yet. Share an insight, caveat, or question.
Corcoran et al. (2020) conducted an RCT in elective noncardiac surgery (n=302). Dexamethasone vs. Placebo was evaluated on Maximum blood glucose within 24 h of surgery. Intra-operative dexamethasone (4 mg or 8 mg) did not induce greater hyperglycaemia compared with placebo in nondiabetic and well-controlled diabetic patients undergoing noncardiac surgery.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: