The SAFER initiative: Register your interest in the future project of the MOPED-MAD research network

The use of advanced diabetes technologies, such as continuous glucose monitors (CGMs), subcutaneous insulin pumps, and automated insulin delivery (AID) systems, has become increasingly prevalent, significantly improving glycaemic control and patient quality of life. (1, 2) Approximately 20% of surgical patients have diabetes, bringing these technologies into the perioperative setting. (3) However, none of these devices is currently approved for use during procedures involving ionising radiation or electrocautery. 

Standard perioperative protocols often require the removal of these devices and the initiation of intravenous insulin therapy, coupled with point-of-care (POC) glucose monitoring. This approach increases the risk of iatrogenic hypo- or hyperglycaemia, diabetic ketoacidosis, and patient discomfort. It also contributes to higher healthcare costs, as only a limited number of sensors and infusion sets are reimbursed. (4, 5) 

Maintaining normoglycaemia is of utmost importance in the hospital. Both hypo- and hyperglycaemia are associated with morbidity (e.g. wound infections) and mortality (3, 6). Despite the preference of many patients and healthcare professionals to continue diabetes devices during procedures, a formal protocol is lacking due to the absence of robust safety data. Drawing inspiration from studies demonstrating the safe continuation of pacemakers in surgical settings and a limited number of case reports, we hypothesise that continuation of a patient’s personal diabetes device during electrocautery is both safe and beneficial. (7-9) 

In this multicentre international observational cohort study, patients are allowed to continue using their own diabetes device during surgery. We aim to include 400 patients. 

The objectives of this study are to: 

• To quantify the incidence of device malfunction within established safety limits during perioperative use.  
• To identify risk factors for device malfunction. 
• To assess the frequency and type of glycaemic complications during continued device use.  
• To assess patient satisfaction during continuation of their own device 

After the successful completion of the MOPED study, this study is one of the future projects of the MOPED-MAD ESAIC research network. (10,11) 

Each centre is asked to enrol ten patients into the database.  

All participating investigators will be collaborators of the SAFER investigators group and will be included in all publications from the SAFER initiative database. 

Do you want to help shape the future of perioperative care for patients with diabetes? Contact : j.a.polderman@amsterdamumc.nl 

References 

1. Brown SA, Kovatchev BP, Raghinaru D, Lum JW, Buckingham BA, Kudva YC, et al. Six-Month Randomized, Multicenter Trial of Closed-Loop Control in Type 1 Diabetes. N Engl J Med. 2019;381(18):1707-17.
2. Foster NC, Beck RW, Miller KM, Clements MA, Rickels MR, DiMeglio LA, et al. State of Type 1 Diabetes Management and Outcomes from the T1D Exchange in 2016-2018. Diabetes Technol Ther. 2019;21(2):66-72.
3. Martin ET, Kaye KS, Knott C, Nguyen H, Santarossa M, Evans R, et al. Diabetes and Risk of Surgical Site Infection: A Systematic Review and Meta-analysis. Infect Control Hosp Epidemiol. 2016;37(1):88-99.
4. Avari P, Lumb A, Flanagan D, Rayman G, Misra S, Choudhary P, et al. Insulin Pumps and Hybrid Close Loop Systems Within Hospital: A Scoping Review and Practical Guidance From the Joint British Diabetes Societies for Inpatient Care. J Diabetes Sci Technol. 2023;17(3):625-34.
5. Cruz P, McKee AM, Chiang HH, McGill JB, Hirsch IB, Ringenberg K, et al. Perioperative Care of Patients Using Wearable Diabetes Devices. Anesth Analg. 2025;140(1):2-12.
6. Chang SH, Stoll CR, Song J, Varela JE, Eagon CJ, Colditz GA. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012. JAMA Surg. 2014;149(3):275-87.
7. Dominguez-Riscart J, Buero-Fernandez N, Garcia-Zarzuela A, Marmolejo-Franco FA, Perez-Guerrero AC, Lechuga-Sancho AM. Hybrid Closed-Loop System Achieves Optimal Perioperative Glycemia in a Boy With Type 1 Diabetes: A Case Report. Front Pediatr. 2021;9:625390.
8. Gifford J, Larimer K, Thomas C, May P. ICD-ON Registry for Perioperative Management of CIEDs: Most Require No Change. Pacing Clin Electrophysiol. 2017;40(2):128-34.
9. Kim YC, Wolf RM, Busin KM, Vanderhoek SM. Perioperative maintenance of hybrid closed loop insulin pump systems in youth with type 1 diabetes mellitus: A case series. Paediatr Anaesth. 2023;33(10):862-7.
10. Buggy DJ, Columb MO, Hermanides J, Hollmann MW, Coburn M, Zarbock A, on behalf of the MOPED Investigators. Management and Outcomes of Perioperative care of people with Diabetes across Europe (MOPED): A prospective, observational study. The Lancet Regional Health – Europe 2026; 61: 1-15.
11. Buggy DJ, Columb MO, Hermanides J, Hollmann MW, Coburn M, Zarbock A, on behalf of the MOPED Investigators. Withholding or continuing glucose lowering drugs for elective surgery in patients with type II diabetes – A secondary analysis of the MOPED international, prospective, observational study. British Journal of Anaesthesia 2026; doi: 10.1016/j.bja.2026.03.068.

Author

• Jorinde A.W. Polderman