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Perioperative Diabetes — RACP Adult Medicine MCQ

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HardClinical PharmacologyPerioperative DiabetesRACP Adult Medicine

A 65-year-old with type 2 diabetes controlled on metformin and modified-release gliclazide is scheduled first on the morning list for elective surgery. eGFR is 55 mL/min/1.73 m² and no contrast is planned. What should be done with these medicines?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Continue both through the preceding evening, omit both on surgery day and restart after stable oral intake resumes

The best answer is “Continue both through the preceding evening, omit both on surgery day and restart after stable oral intake resumes”. Australian perioperative guidance withholds non-insulin glucose-lowering medicines on the surgery day. Continuing gliclazide while fasting risks hypoglycaemia, whereas metformin can be taken through the previous evening when renal function is stable and no contrast is planned. Prolonged blanket cessation or unnecessary insulin substitution risks avoidable dysglycaemia.

Reference: Australian Diabetes Society and ANZCA: Perioperative diabetes and hyperglycaemia guidelines: https://www.diabetessociety.com.au/guideline/ads-anzca-perioperative-diabetes-and-hyperglycaemia-guidelines-adults-november-2022/ Australian RACP: Divisional Written Examination: https://www.racp.edu.au/trainees/examinations/divisional-written-examination