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Diabetes — Perioperative Management

Diabetes is present in up to 20% of patients undergoing major general surgery, with another 23–60% harboring prediabetes or undiagnosed diabetes.[1] Perioperative hyperglycemia is a risk factor for surgical site infection and other postoperative complications (including concern for prosthetic implant infection), and it is associated with longer stay and higher mortality.[1][3]

See also: Cardiovascular Risk, ERAS, Wound Healing.

Why Glucose Control Matters in GU Reconstruction​

  • Nosocomial infection. In one prospective series of 100 diabetic patients having elective surgery, a glucose >220 mg/dL on POD 1 predicted later nosocomial infection with 87.5% sensitivity but only 33% specificity. Infection was 2.7 times as frequent (31.3% versus 11.5%) with such a value, and the relative risk for serious infection was 5.7 once minor urinary infections were excluded.[15]
  • Prosthetic infection. HbA1c tracks penile implant infection risk (details below). Optimize glycemia as one part of infection prevention alongside technique, skin and urine assessment, and antimicrobial planning. No universal HbA1c cancellation threshold is established.[14][16][17]
  • Wound healing. Hyperglycemia impairs collagen cross-linking, fibroblast function, and neutrophil chemotaxis.
  • Anastomotic healing. Diabetes and hyperglycemia are thought to impair anastomotic healing (microvascular disease, collagen and leukocyte dysfunction); reconstructive-specific data are mostly observational.
  • Perioperative MACE. Diabetes is one of the six RCRI variables; insulin-dependence specifically scores a point.

A meta-analysis of 15 RCTs (patients with and without diabetes) found that intensive protocols aiming for glucose <150 mg/dL lowered SSI (OR 0.43, 95% CI 0.29–0.64) at the cost of more hypoglycemia (OR 5.55).[5] In trials restricted to people with diabetes, the 2023 Cochrane review found no clear difference in pooled postoperative infectious complications (160/1,228 [13.0%] versus 224/1,225 [18.3%]; RR 0.75, 95% CI 0.55–1.04; low-certainty evidence).[2] WHO conditionally recommends protocols for intensive perioperative glycemic control in adults with or without diabetes to reduce SSI.[3] Perioperative management aims to avoid sustained hyperglycemia without targeting near-normal values.

Preoperative Targets (2026 ADA)​

HbA1c / Glucose Management Indicator​

  • Target A1c <8% (<64 mmol/mol) within 3 months of elective surgery, with individualized risk-to-benefit assessment.[1]
  • Alternatively, CGM data showing 14-day GMI <8% or time-in-range >50%, or both.[1]
  • Do not use A1c or GMI alone as an automatic cancellation rule. ADA advises against postponement solely on either value because interventional data are lacking and unnecessary delay or denial of required surgery may result.[1] The 2024 AHA/ACC guideline says elective postponement may be reasonable above A1c 8%, although no cardiovascular benefit from deferral has been demonstrated; emergent or time-sensitive procedures should not be delayed to reach an A1c target, and perioperative glucose control should be optimized.[7] Optimization programs have been associated with better perioperative glycemic management and shorter stay.[1]

Who Needs Tighter Preoperative Optimization​

  • Elective prosthetic urologic surgery. Infection risk rises with HbA1c. In a prospective multicenter series of 902 implants (76% malleable), infection was 1.3% with HbA1c <6.5%, 1.5% at 6.5–7.5%, 6.5% at 7.6–8.5%, 14.7% at 8.6–9.5% and 22.4% above 9.5%; an 8.5% cutoff predicted infection with 80% sensitivity and 65% specificity.[16] A 2026 meta-analysis of 11 mostly retrospective studies (10,024 men) found infection of 9.1% in cohorts with mean HbA1c ≥8% versus 3.8% in the rest, and called for better threshold studies.[17] Use these data to counsel, to push optimization before elective implantation, and to set a local threshold.[14]
  • Major reconstructive operations with bowel use. For elective cystectomy with diversion or augmentation cystoplasty, consider the ADA's individualized preoperative A1c goal of <8% within 3 months.[1]
  • Time-sensitive cancer cases. Do not defer solely to reach an A1c target; assess and treat suspected DKA or HHS before anesthesia, then optimize perioperative glucose.[1][7][12]

Perioperative Glycemic Targets​

SettingTargetReference
Critically ill / ICU140–180 mg/dL once insulin started (ADA 16.5a, Grade A)[1][4]
Non-critically ill100–180 mg/dL if achievable without significant hypoglycemia (ADA 16.5b, Grade B)[1]
Pre-, intra-, and postoperative100–180 mg/dL; goals may differ by surgery, hypoglycemia risk, and glucose-lowering therapy (ADA 16.15, Grade E)[1]
Intraoperative ambulatory surgery in adults with diabetes180–250 mg/dL based on patient and procedure characteristics (2024 SAMBA, Strong; moderate evidence)[24]

For persistent glucose at least 180 mg/dL on two checks within 24 hours, ADA advises insulin for most ICU patients (16.4a, Grade A) and insulin and/or other glucose-lowering therapies for most noncritically ill patients (16.4b, Grade B). Check A1c on admission when diabetes or hyperglycemia is present and no result is available from the prior 3 months (16.1, Grade B).[1]

Avoid routine intensive targets such as 80–110 mg/dL.[1] ADA allows more stringent individualized ICU goals for selected patients when achievable without significant hypoglycemia.[1] The NICE-SUGAR trial (6,104 ICU patients) showed intensive control (80–110 mg/dL) produced:[4]

  • Higher 90-day mortality: 829/3,010 (27.5%) with intensive control versus 751/3,012 (24.9%) with conventional control targeting glucose at or below 180 mg/dL (OR 1.14, 95% CI 1.02–1.28).[4]
  • Severe hypoglycemia (glucose ≤40 mg/dL) in 6.8% vs 0.5% (206/3,016 vs 15/3,014).[4]

A 2023 Cochrane review confirmed intensive control gives little or no mortality difference, a possible but uncertain reduction in cardiovascular events, and a RR 4.73 for severe hypoglycemia.[2]

In perioperative patients with diabetes, pooled data associate a moderate target (150–200 mg/dL) with lower mortality and stroke than a liberal target (>200 mg/dL); no significant outcome differences were found between moderate and stricter (<150 mg/dL) targets.[6] ADA recommends 140–180 mg/dL for most critically ill patients with hyperglycemia once therapy starts, and 100–180 mg/dL for noncritically ill patients if achievable without significant hypoglycemia.[1]

Insulin Therapy​

Regimen Principles[1]​

  • Use insulin for glucose management during the procedure. Medication holds depend on drug class and timing; individualized GLP-1 decisions are described below.
  • Basal-bolus. Basal plus premeal short- or rapid-acting insulin outperforms correction-only (sliding-scale) regimens for inpatient glycemic outcomes; use basal-bolus when the patient is eating.
  • Sole use of sliding-scale insulin without basal is discouraged (ADA 16.10; the Endocrine Society 2022 non-critical-care guideline likewise favors basal or basal-plus-correction regimens).[10]
  • Continuous IV insulin infusion is the preferred regimen for critically ill patients.

Dose Adjustments the Night Before Surgery[1]​

InsulinPreop adjustment
Long-acting basal (glargine, detemir, degludec)75–80% of usual dose the evening before
NPH (intermediate)Individualize the preceding evening dose; give 50% of the usual morning dose on surgery day[1][22]
Prandial / rapid-actingHold while NPO

A 25% reduction of the evening-before basal dose is more likely to achieve perioperative glucose goals with lower hypoglycemia risk than the usual dose. ADA notes the reduction may not suit some people with type 1 diabetes, who need enough basal insulin to avoid ketoacidosis.[1] Adjust pump basal rates similarly when the pump is not in automated mode.

Morning of Surgery​

  • Hold prandial / rapid-acting insulin.
  • Continue adjusted basal (75–80% long-acting, 50% NPH), individualized to the patient.[1]
  • Check POC glucose on arrival.
  • Use IV insulin for critical illness or a hyperglycemic crisis. For noncritically ill patients who are not eating, use basal or basal-plus-correction insulin.[1]

By Clinical Setting[8]​

Type 1 diabetes or insulin-dependent type 2:

Eating statusPlan
EatingIndividualize basal + prandial + correction to intake, glucose, and home doses[1]
NPOContinue individualized basal plus correction; hold prandial insulin while fasting[1]

Type 2 diabetes, not on insulin:

Eating statusPlan
EatingFor elective surgery, hold SGLT2 inhibitors for 3–4 days beforehand, individualize GLP-1 receptor agonist use, and hold other oral glucose-lowering agents on the day of surgery. Outside the perioperative period, initial correction insulin is an option for noncritically ill adults previously managed with diet or noninsulin drugs when admission glucose is <180 mg/dL; selected stable noncritical patients with mild type 2 diabetes hyperglycemia may use a DPP-4 inhibitor with correction; for most noncritically ill inpatients with glucose ≥180 mg/dL on two checks within 24 hours, initiate or intensify insulin and/or another glucose-lowering therapy (ADA 16.4b, B).[1][10]
NPOStop non-insulin agents; start correction
Persistent hyperglycemia (glucose ≥180 mg/dL on two checks within 24 h)Initiate or intensify insulin and/or other glucose-lowering treatment; select basal + prandial + correction with adequate intake or basal + correction with poor/no intake as clinically indicated[1]

Non-Insulin Medications​

Metformin​

  • Hold on day of surgery.
  • The 2024 AHA/ACC guideline permits perioperative continuation (Class IIa); the theoretical lactic-acidosis risk is not well-supported by modern data.[7]
  • Contrast is a separate decision: ACR permits metformin continuation for IV iodinated contrast when there is no AKI and eGFR ≥30 mL/min/1.73 m².[13] With AKI, eGFR <30, or relevant arterial catheter studies, withhold at/before the procedure and for 48 h afterward, then reassess renal function.[13] US metformin labeling is more restrictive: stop at or before iodinated contrast when eGFR is 30–60, with hepatic impairment, alcoholism or heart failure, or with intra-arterial contrast, and restart after eGFR is re-evaluated at 48 h and found stable.[18]

Sulfonylureas (Glipizide, Glyburide, Glimepiride)​

  • Hold on the day of surgery. Hypoglycemia risk while NPO.

SGLT2 Inhibitors (Canagliflozin, Dapagliflozin, Empagliflozin, Ertugliflozin)​

  • Hold 3 days before elective surgery (4 days for ertugliflozin), consistent with ADA (3–4 days), AHA/ACC 2024 (Class I) and US labeling for empagliflozin (at least 3 days) and ertugliflozin (at least 4 days).[1][7][9][19]
  • Mechanism for timing: half-lives and the risk window for euglycemic DKA, a documented perioperative emergency where DKA occurs with normal or near-normal glucose.
  • After nonelective surgery with recent SGLT2 inhibitor exposure, monitor for postoperative DKA, including euglycemic DKA.[1] For a heart-failure indication, the drug may be restarted in the hospital when nutritional intake resumes and ketoacidosis risk factors have resolved.[1]

GLP-1 Receptor Agonists (Semaglutide, Liraglutide, Tirzepatide, Dulaglutide)​

The 2023 ASA guidance suggested holding weekly GLP-1s a week before surgery and daily agents on the day of surgery because of delayed gastric emptying and aspiration risk; the 2024 AHA/ACC guideline makes no formal recommendation on GLP-1 agonists. Its text cites the ASA consensus of holding weekly agents for more than a week and daily agents the day before elective surgery.[1][7] FDA labeling for all GLP-1 RAs and dual GIP/GLP-1 RAs warns of pulmonary aspiration with general anesthesia or deep sedation, and ADA notes that a one-week hold of a weekly agent may not empty the stomach.[1] The 2026 ADA now advises a personalized approach, in line with the 2024 multisociety guidance (ASA, AGA, ASMBS, ISPCOP, SAGES):[1][20]

  • Elective surgery: assess dose escalation, higher dose, weekly formulation, GI symptoms, and coexisting gastroparesis or other dysmotility. Continuation is reasonable when delayed-emptying risk is low.[20]
  • Active GI symptoms (nausea, vomiting, dyspepsia, abdominal distension): ADA says full stomach precautions may be considered; the multisociety guidance also allows delaying an elective procedure.
  • Preoperative gastric ultrasound may be considered to quantify gastric contents.
  • Preoperative liquid diet. The 2024 multisociety guidance suggests a 24-hour liquid diet for patients at higher risk of delayed gastric emptying; the 2025 SPAQI consensus recommends a 24-hour clear-liquid diet for GLP-1 users without significant gastrointestinal symptoms (Grade B).[20][22]
  • Use alternative glycemic management (insulin) if the agent is held and worsening glycemia is expected.

See Perioperative Nutrition for the aspiration-planning evidence, including the OCULUS trial, and Cardiovascular Risk for the SGLT2 and cardiac-medication rules.

DPP-4 Inhibitors (Sitagliptin, Linagliptin)​

  • Hold on the day of surgery. ADA advises holding metformin and other oral glucose-lowering agents that day. Selected stable inpatients with mild to moderate hyperglycemia may receive DPP-4 inhibitors outside the procedural setting.[1]

Thiazolidinediones (Pioglitazone)​

  • Hold on day of surgery. Fluid retention.

Glucose Monitoring​

  • POC monitoring. Check glucose at least every 2–4 hours while NPO, every 30 minutes to 2 hours during IV insulin therapy, and before meals when eating.[1]
  • CGM cannot be used alone for surgical glucose monitoring; confirmatory POC is required before insulin dosing.
  • For hospitalized CGM use, compare readings with POC or laboratory glucose: within ±20% when glucose is >70 mg/dL, or within ±20 mg/dL when it is ≤70 mg/dL.[1]

Insulin Pumps and Automated Insulin Delivery​

Pumps may be continued intraoperatively if institutional policy and the procedure allow.[1]

  • Patient must be able to self-manage (or have a support person present).
  • Adequate supplies and trained staff.
  • Reasons to stop patient-managed pump use include impaired consciousness (except short-term anesthesia), critical illness requiring intensive care, DKA/HHS, or inability to demonstrate appropriate pump settings.[23]
  • If the pump cannot be used during surgery, initiate an insulin infusion or basal-plus-correction plan before surgery.[1] For a planned subcutaneous transition, give basal insulin at least 2 hours before stopping the pump.[23]

Automated insulin delivery (hybrid closed-loop) systems may continue if CGM and pump function are preserved; revert to manual mode if CGM fails.

Special Situations​

Steroid-Induced Hyperglycemia​

Perioperative steroids (adrenal-insufficiency stress dosing, dexamethasone antiemesis, chronic prednisone) cause predictable hyperglycemia. With morning prednisone, glucose is near normal or mildly high fasting and climbs through the afternoon to an evening peak, more so in type 2 diabetes.[1]

  • Once- or twice-daily prednisone: give NPH insulin with the steroid dose, because NPH peaks 4–6 h later. A commonly used starting schema is about 0.1 U/kg/day of NPH for each 10 mg of prednisone equivalent, titrated to glucose.[8]
  • Dexamethasone or continuous or multidose glucocorticoids. Long-acting basal insulin is often needed for fasting glucose, and with higher glucocorticoid doses, prandial and correction doses may need to rise by 40–60% or more.[1]

Enteric Feeding​

  • Start weight-based basal plus correction insulin.
  • Check glucose every 4–6 h, matched to the insulin used.
  • Keep basal insulin, even if feeds stop in type 1 diabetes, and cover the nutrition load separately, about 1 U per 10–15 g carbohydrate. For continuous feeds use rapid-acting insulin every 4 h, regular insulin every 6 h or NPH every 8–12 h; bolus feeds need rapid-acting insulin before each feed. If feeds are interrupted, give IV dextrose for the duration of insulin action.[1]

Total Parenteral Nutrition​

  • Add regular insulin directly to the TPN bag at a starting dose of about 1 U per 10 g dextrose, particularly if >20 U of correction insulin were needed in the prior 24 h; adjust daily.[1]
  • Add subcutaneous correction insulin for residual glucose excursions.

Diabetic Ketoacidosis in the Surgical Patient​

Can occur postoperatively in T1DM with inadequate basal coverage, or euglycemic DKA with SGLT2 inhibitor continuation through surgery.[11]

Diagnosis requires diabetes or hyperglycemia plus ketosis and acidosis: blood β-hydroxybutyrate ≥3 mmol/L (or urine ketones ≥2+) with pH <7.3 or bicarbonate <18 mmol/L, or both. Prior diabetes can satisfy the glucose criterion even when glucose is <200 mg/dL.[12]

Use the institutional DKA protocol with frequent glucose, electrolyte and ketone reassessment. The 2024 international consensus states:[12]

  1. Give isotonic saline or balanced crystalloid, adjusting volume to hemodynamics and cardiac and renal function.
  2. Assess potassium before insulin. If K <3.5 mmol/L, replace it and defer insulin until K >3.5; add replacement when K falls below 5.0 to target 4–5 mmol/L.[12]
  3. IV insulin commonly starts at 0.1 U/kg/h.[12] When glucose falls below 250 mg/dL, add 5–10% dextrose and reduce insulin to 0.05 U/kg/h while clearing ketosis; in euglycemic DKA, start 5–10% dextrose with the initial IV fluids.[12]
  4. Bicarbonate is not routine; consider it for severe acidosis with pH <7.0.
  5. Resolution requires ketones <0.6 mmol/L and pH ≥7.3 or bicarbonate ≥18.[12] Anion-gap closure alone is not a resolution criterion. Overlap subcutaneous basal insulin with IV insulin for 1–2 h when transitioning.

GU-Reconstruction–Specific Considerations​

Prosthetic Urology — AUS, IPP, Sling​

Glycemic control is one modifiable risk factor alongside surgical technique, skin and urinary infection assessment, device selection and antimicrobial planning. The strongest HbA1c data concern penile implants; optimize glycemia before elective implantation without treating 7–7.5% as a validated target or 8.5% as a mandatory cancellation cutoff for all devices.[14][16][17] Choose prophylaxis using the procedure-specific protocol, allergies, renal function and local resistance data; see the prosthetic infection prevention hub.

Urinary Diversion (Cystectomy + Ileal Conduit / Neobladder)​

  • Bowel prep day with NPO status in a patient with insulin-dependent diabetes carries a high risk of hypoglycemia; hold oral agents, reduce basal, maintain IV dextrose if needed.
  • Return-of-feeding gap. Preserve basal insulin in type 1 diabetes; stable ward patients generally use subcutaneous basal plus correction coverage. Reserve infusion for clinical need rather than an automatic postoperative day count.[1]
  • Metabolic acidosis from ileal diversion can worsen any underlying diabetic ketogenesis; monitor bicarbonate.

Neurogenic / Diabetic Bladder Dysfunction​

  • Diabetic bladder dysfunction can present with storage symptoms and detrusor overactivity as well as impaired sensation, underactivity, and retention. In a 50-patient type 2 diabetes/LUTS cohort, overactivity was more frequent with shorter disease duration, while weak or absent contractility was more frequent with longer duration; ask about both storage and emptying symptoms before reconstruction.[21]
  • Post-obstructive diuresis after relief of diabetic neurogenic retention can cause profound electrolyte and glycemic shifts.

Renal Function​

Many long-standing diabetics have diabetic nephropathy. This affects:

  • DOAC dose selection.
  • Metformin continuation and contrast loading.
  • Gentamicin and aminoglycoside dosing for prosthetic prophylaxis.
  • ERAS fluid-balance decisions.

Summary of Key Recommendations​

RecommendationEvidence
Preoperative A1c <8% target within 3 months of elective surgery (individualize)ADA 16.14, C[1]
Perioperative glucose target 100–180 mg/dL (floor), 140–180 (ICU)ADA 16.15, E; ICU target 16.5a, A
Basal-bolus insulin, not sliding-scale alone, in the inpatientADA 16.9–16.10, A
Do NOT use tight glycemic control (80–110) — NICE-SUGAR / CochraneA
Hold SGLT2 inhibitors 3–4 days before surgeryADA text; AHA/ACC 2024 Class I; FDA labeling[1][7]
Personalized hold strategy for GLP-1 receptor agonistsADA 2026 text; multisociety guidance
Hold metformin on the day of surgery (ADA); continuation is reasonable per AHA/ACCADA text; ACC Class IIa
Use 75–80% of usual long-acting basal dose the evening before surgery; individualize the preceding evening NPH dose and use 50% of the usual morning NPH dose on surgery dayADA text[1]
CGM should not be used alone during surgeryADA text
Insulin pumps may continue with institutional supportADA 16.7, C

References​

1. American Diabetes Association Professional Practice Committee. "16. Diabetes Care in the Hospital: Standards of Care in Diabetes — 2026." Diabetes Care. 2026;49(Suppl_1):S339–S355. doi:10.2337/dc26-S016

2. Bellon F, Solà I, Gimenez-Perez G, et al. "Perioperative Glycaemic Control for People With Diabetes Undergoing Surgery." Cochrane Database Syst Rev. 2023;8:CD007315. doi:10.1002/14651858.CD007315.pub3

3. Allegranzi B, Zayed B, Bischoff P, et al. "New WHO Recommendations on Intraoperative and Postoperative Measures for Surgical Site Infection Prevention." Lancet Infect Dis. 2016;16(12):e288–e303. doi:10.1016/S1473-3099(16)30402-9

4. NICE-SUGAR Study Investigators, Finfer S, Chittock DR, et al. "Intensive Versus Conventional Glucose Control in Critically Ill Patients." N Engl J Med. 2009;360(13):1283–97. doi:10.1056/NEJMoa0810625

5. de Vries FE, Gans SL, Solomkin JS, et al. "Meta-Analysis of Lower Perioperative Blood Glucose Target Levels for Reduction of Surgical-Site Infection." Br J Surg. 2017;104(2):e95–e105. doi:10.1002/bjs.10424

6. Sathya B, Davis R, Taveira T, Whitlatch H, Wu WC. "Intensity of Peri-Operative Glycemic Control and Postoperative Outcomes in Patients With Diabetes: A Meta-Analysis." Diabetes Res Clin Pract. 2013;102(1):8–15. doi:10.1016/j.diabres.2013.05.003

7. Thompson A, Fleischmann KE, Smilowitz NR, et al. "2024 AHA/ACC Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery." J Am Coll Cardiol. 2024;84(19):1869–1969. doi:10.1016/j.jacc.2024.06.013

8. Gauer RL, Abellada A, Stewart M, Kozloski R. "Managing Selected Chronic Conditions in Hospitalized Patients." Am Fam Physician. 2024;109(2):134–142. PMID 38393797

9. Winchester DE, Mehta JJ, Alexander JT. "Perioperative Cardiovascular Medication Management for Noncardiac Surgery." JAMA. 2026. doi:10.1001/jama.2026.0067

10. Korytkowski MT, Muniyappa R, Antinori-Lent K, et al. "Management of Hyperglycemia in Hospitalized Adult Patients in Non-Critical Care Settings — Endocrine Society Clinical Practice Guideline." J Clin Endocrinol Metab. 2022;107(8):2101–2128. doi:10.1210/clinem/dgac278

11. Veauthier B, Levy-Grau B. "Diabetic Ketoacidosis: Evaluation and Treatment." Am Fam Physician. 2024;110(5):476–486. PMID 39556629

12. Umpierrez GE, Davis GM, ElSayed NA, et al. "Hyperglycaemic crises in adults with diabetes: a consensus report." Diabetologia. 2024;67:1455–1479. doi:10.1007/s00125-024-06183-8. Full text.

13. American College of Radiology. Manual on Contrast Media, Metformin chapter. Official manual. Accessed September 11, 2026.

14. "The International Penile Prosthesis Implant Consensus Forum: clinical recommendations and surgical principles on the inflatable 3-piece penile prosthesis implant." Nature Reviews Urology. 2022. doi:10.1038/s41585-022-00607-z.

15. Pomposelli JJ, Baxter JK 3rd, Babineau TJ, et al. "Early Postoperative Glucose Control Predicts Nosocomial Infection Rate in Diabetic Patients." JPEN J Parenter Enteral Nutr. 1998;22(2):77–81. doi:10.1177/014860719802200277

16. Habous M, Tal R, Tealab A, et al. "Defining a Glycated Haemoglobin (HbA1c) Level That Predicts Increased Risk of Penile Implant Infection." BJU Int. 2018;121(2):293–300. doi:10.1111/bju.14076

17. Corona G, Capogrosso P, Lee WG, et al. "Penile Prosthesis Infection and Diabetes Mellitus: A Systematic Review and Meta-Analysis." J Sex Med. 2026;23(1):qdaf340. doi:10.1093/jsxmed/qdaf340

18. Glipizide and Metformin Hydrochloride Tablets, prescribing information (Warnings: lactic acidosis, radiologic studies with contrast). DailyMed. dailymed.nlm.nih.gov. Accessed September 25, 2026.

19. Jardiance (empagliflozin) and Steglatro (ertugliflozin) prescribing information, section 2.3 (temporary interruption for surgery). DailyMed. dailymed.nlm.nih.gov. Accessed September 25, 2026.

20. Kindel TL, Wang AY, Wadhwa A, et al. "Multisociety Clinical Practice Guidance for the Safe Use of Glucagon-Like Peptide-1 Receptor Agonists in the Perioperative Period." Surg Obes Relat Dis. 2024;20(12):1183–1186. doi:10.1016/j.soard.2024.08.033

21. Elsakka H, Ibrahim A, Khogeer A, et al. "Evaluation of urodynamic pattern in short and long-standing diabetic patients." Arch Ital Urol Androl. 2023;95(1):11072. doi:10.4081/aiua.2023.11072

22. Oprea AD, et al. "Perioperative management of patients taking glucagon-like peptide 1 receptor agonists: Society for Perioperative Assessment and Quality Improvement (SPAQI) multidisciplinary consensus statement." Br J Anaesth. 2025;135(1):48–78. doi:10.1016/j.bja.2025.04.001

23. Umpierrez GE, Klonoff DC. "Diabetes Technology Update: Use of Insulin Pumps and Continuous Glucose Monitoring in the Hospital." Diabetes Care. 2018;41(8):1579–1589. doi:10.2337/dci18-0002

24. Rajan N, Duggan EW, Abdelmalak BB, et al. "Society for Ambulatory Anesthesia Updated Consensus Statement on Perioperative Blood Glucose Management in Adult Patients With Diabetes Mellitus Undergoing Ambulatory Surgery." Anesth Analg. 2024;139(3):459–477. doi:10.1213/ANE.0000000000006791