MOPED Published: The largest descriptive study of the perioperative journey of people with diabetes across Europe

Study Overview
The MOPED study, a landmark international project sponsored by ESAIC, has just been published in The Lancet Regional Health – Europe. This prospective observational study documented how people with diabetes are managed around the time of surgery across Europe and how these practices impact 30-day postoperative outcomes.

The Numbers

>6,000 patients • 89 hospitals • 21 countries • 150 collaborators 

What We Discovered

• 🏥 Care Varies by Location: The study uncovered wide hospital-to-hospital and country-to-country differences in managing surgical patients with diabetes. For example, one key outcome – “Days at Home by 30 days after surgery” (DAH-30) – ranged from a median of 23 days in some countries to 30 days in others. In practical terms, patients in certain healthcare systems spent up to a week less at home after surgery, due to where their surgery took place. This outcome difference was not attributable to patient factors. Whether a patient had type 1 or type 2 diabetes made no significant difference in their 30-day results. While this may have been due to differences in local hospital resourcing and case-mix complexity, our data suggests that there is considerable variability in practice and protocols.
• 💉 Preoperative Glycaemic Control Matters: Long-term blood sugar control correlated with recovery. Patients with lower long-term blood  glucose (lower preoperative HbA_1c) tended to get home sooner after surgery than those with poorly controlled diabetes. Notably, individuals with high HbA_1c (>69 mmol/mol) had a median of 25 days at home out of  30 days post-surgery, compared to 27 days for those with lower HbA_1c (<53 mmol/mol). In other words, poorer glycaemic control before surgery was associated with around twofewer  days at home within the first month of recovery. This emphasises that better diabetes management leading up to surgery may improve postoperative recovery.
• 🌍 Call for Standardised Protocols: The pronounced variability in practice and outcomes highlighted by MOPED signals a need to further harmonise perioperative diabetes care across Europe. Many participating centres followed different guidelines (or lack thereof) for insulin use, glucose monitoring, and postoperative care, resulting in inconsistent patient experiences. Developing unified, evidence-based protocols – for example, standard blood glucose targets, consistent use of insulin infusions, and involvement of diabetes teams in surgical care – could reduce these disparities. The investigators suggest that adopting common best practices will help ensure that a patient with diabetes receives optimal care no matter where they have surgery.

What Does It Mean?

• For Patient Care: When two similar patients have different postoperative outcomes solely because of variation in care practices, it raises concerns about equity and quality. MOPED’s findings are a wake-up call that surgical patients with diabetes should receive consistent care everywhere. Standardising perioperative diabetes management can improve safety – for instance, avoiding unnecessary hyperglycaemia or hypoglycaemia – and potentially shorten hospital stays. For patients, this means a better chance at smooth recovery and fewer complications, regardless of which hospital or country they are treated in.
• For Healthcare Systems: Health systems and hospitals should prioritise implementing uniform diabetes care protocols during the surgical pathway. The data suggest that investing in structured care – such as dedicated perioperative diabetes management teams or checklists – could pay off in improved outcomes and more efficient care (fewer prolonged hospitalisations and readmissions). Policymakers and professional societies may need to update or unify guidelines to reduce contradictory practices. Moreover, the MOPED investigators note that further research, including clinical trials of specialised care pathways for high-risk diabetic patients, may be warranted to identify the best approaches to improving perioperative outcomes. In summary, harmonising care standards across Europe is not only a matter of fairness but could also reduce complication rates and healthcare costs in the long run.

Read More: The full MOPED results are available open-access in The Lancet Regional Health – Europe (Feb 2026). Readers can refer to the published article for detailed data and supplementary materials, including the complete list of investigators and in-depth statistical analysis (DOI: 10.1016/j.lanepe.2025.101535).

Chief investigator – first author – corresponding author:

Prof. Donal J. Buggy – Department of Anaesthesiology, Mater Misericordiae University Hospital, School of Medicine, University College Dublin, Ireland. Outcomes Research Consortium, University of Houston, TX, USA.

Other main authors

• Dr. Malachy O. Columb – Department of Anaesthesiology and Intensive Care Medicine, Manchester University Hospitals Foundation NHS Trust, Wythenshawe, United Kingdom.
• Prof. Jeroen Hermanides – Department of Anaesthesiology, Research Institutes Amsterdam Cardiovascular Sciences & Amsterdam Public Health, Amsterdam University Medical Center, Amsterdam, the Netherlands.
• Prof. Markus W. Hollmann – Department of Anaesthesiology, Research Institutes Amsterdam Cardiovascular Sciences & Amsterdam Public Health, Amsterdam University Medical Center, Amsterdam, the Netherlands.
• Prof. Mark Coburn – Department of Anaesthesiology and Operative Intensive Care, University Hospital Bonn, Germany.
• Prof. Alexander Zarbock – Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Germany. Department of Anaesthesiology, University of Texas, McGovern Medical School, Houston, TX, USA.