The effect of intraoperative dexamethasone on glycaemic responses in people with diabetes mellitus: a preplanned analysis of the Perioperative ADministration of Dexamethasone and Infection trial

doi:10.1016/j.bja.2026.05.009

The effect of intraoperative dexamethasone on glycaemic responses in people with diabetes mellitus: a preplanned analysis of the Perioperative ADministration of Dexamethasone and Infection trial

Br J AnaesthPublished 16 Jun 2026Secondary analysis of the Perioperative ADministration of Dexamethasone and Infection (PADDI) randomised trial

Primary resultResultEstimated difference 1.86 mM 95% CI 1.50–2.22

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Authors' conclusion

In people with diabetes mellitus, dexamethasone was associated with a modest increase in perioperative blood glucose but not with increased surgical-site infection.

Study context

Population: PADDI participants with DM and glycated haemoglobin <9.0% undergoing nonurgent, noncardiac surgery
Participants: 1,130 participants

Comparison: Single 8 mg intraoperative dexamethasone vs placebo
Dexamethasonen = 570
Placebon = 560reference
Primary endpoint: Maximum recorded perioperative blood glucose concentration (mM)
Follow-up: Within 24 h of anaesthesia induction

Methodological detailspreplanned sub-study, placebo-controlled, as treated analysis

Preplanned sub-study
Placebo-controlled
As treated analysis

Primary result

As reported in the abstract

Estimated difference

1.86 mM

95% CI 1.50–2.22

P < 0.001

By group

Dexamethasone12.5median · IQR 10.6–15.0 · mM

Placebo10.3median · IQR 8.8–12.4 · mM

Dexamethasone vs Placebo

estimated difference 1.86 mM (95% CI 1.50–2.22); P < 0.001

Further findings

Outcome	Dexamethasone	Placebo	← Lower risk with dexamethasone ←→ Higher risk with dexamethasone →	RR (95% CI)
Surgical-site infectionNo evidence of increased risk	11.1%	14.4%	0.512	0.74 (0.54–1.01)
			0.512Relative risk (log scale)

Age, sex, BMI and HbA1c (subgroup)

Not associated with maximum perioperative glucose or surgical-site infection between groups

Safety

Additional insulin requirement and hypoglycaemic episodes

Did not differ between groups

Original publication

The effect of intraoperative dexamethasone on glycaemic responses in people with diabetes mellitus: a preplanned analysis of the Perioperative ADministration of Dexamethasone and Infection trial. Br J Anaesth. Published 16 June 2026. doi:10.1016/j.bja.2026.05.009

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