Perioperative anesthesia care for patients with diabetes mellitus: a review of current literature with focus on oral antidiabetic medication

PURPOSE OF REVIEW: Every fifth surgical patient presents with diabetes mellitus and the use of modern oral antidiabetic agents is rapidly expanding. Therefore, comprehensive and current knowledge of benefits and risks is essential for anesthesiologists. RECENT FINDINGS: The 2025 international guidelines for perioperative management of patients with type 2 diabetes mellitus recommend continuation of glucagon-like peptide-1 receptor agonists in patients without an elevated risk of aspiration, temporary discontinuation of sodium-glucose-co-transporter-2 inhibitors one to four days before surgery, and do not provide specific recommendations for dipeptidyl peptidase-4 inhibitors. Emerging evidence focuses on two principal areas: the additive metabolic and cardiovascular benefits of combination therapy, and the real-world perioperative safety of these agents. Large cohort studies now demonstrate exceedingly low incidences of pulmonary aspiration and euglycemic ketoacidosis, with adverse events previously documented predominantly in case reports. SUMMARY: Detailed pathophysiological understanding of the mechanisms, benefits, and potential risks associated with oral antidiabetic agents remains indispensable and should foster individualized, risk-based perioperative management strategies for patients with diabetes mellitus.