What is the MOPED Study?  

MOPED is the acronym for Management and Outcomes of the Perioperative Care of European people with Diabetes. 

The ESAIC’s Clinical Studies Network was funded almost entirely by the ESAIC, with smaller contributions from the College of Anaesthesiologists of Ireland (CAI) and the British Journal of Anaesthesia (BJA). 

MOPED is the largest ever study of the perioperative journey of people with diabetes (DM).  

It is a prospective, observational cohort study of >6,100 people with diabetes from 89 centres across 21 countries, conducted over a 3-year period.  

What did MOPED measure? 

The primary outcome measure was Days at Home at 30 days (DAH-30). Secondary outcomes included a composite of postoperative complications and dysglycaemia (blood glucose >12 or <5 mmol/L). 

What did MOPED find? 

1. There is significant variation in perioperative management of people across Europe between countries and between centres, and this is associated with differences in DAH-30 outcome; 
2. Variable prevalence of T1DM and T2DM between countries, suggesting variable or confused diagnostic labelling between countries; 
3. A majority of T2DM patients on metformin (60-85%) stopped taking it on the day of surgery, despite unanimity among guidelines that metformin should be continued; 
4. The biomarker HbA1c, taken 3 months prior to surgery, is widely recommended as an indicator of long-term glycaemic control, but there was variable availability of preoperative HbA1c and only half of the patients had one at all; 
5. This is the first prospective study to demonstrate an association between preoperative HbA1c and postoperative outcome, although this association was upheld in multivariable analysis only where there was little surgical bleeding. 

Why does this matter? 

There is a need to harmonise international practice to reduce variability and hence optimise the 30-day outcome in perioperative diabetes management. 

MOPED’s first Secondary Analysis: 

Should we be withholding or continuing glucose-lowering drugs (GLD) in T2DM patients undergoing surgery? 

This MOPED analysis focused on metformin, SGLT2i and GLP1-RA drugs. 

1. Among 3623/5767 (73%) participants receiving metformin, DAH-30 was higher (28 days [24—29]) in 421/3623 (12%) participants who continued metformin on the day of surgery compared with 27 days (23—29) in 3202 of 5767 (88%) participants who had not taken metformin (P=0.001). 
2. After adjusting for prespecified covariates, continuing metformin on the day of surgery remained associated with higher DAH-30 (0.47 days [95% confidence interval:0.01—0.93]; P=0.044).  
3. However, the minimum clinically significant difference in DAH-30 has been reported as 3 days, although many patients assert that any improvement in days at home after surgery is worthwhile; 
4. No association was found for either stopping/continuing SGLT2i (n=836 participants) or GLP-1 RA (n=304 participants) with DAH-30.  
5. There were no major differences in other complications whether the GLDs were withheld or continued, although the sample sizes in these cohorts were probably too small to draw definitive conclusions. 

Key finding 

Continuing metformin during surgery among patients with type 2 diabetes mellitus was associated with marginally shorter DAH-30, but the sample size for participants receiving SGLT2i and GLP-1 RA therapy precluded any meaningful estimates.  

 We would also like to thank all investigators across participating centers, as well as the ESAIC Research Department, for the dedication and collaboration that made these valuable studies possible. Many more promising initiatives are still to come. 

Read the full papers:  

• Management and Outcomes of Perioperative Care of People with Diabetes across Europe (MOPED) 
• Withholding or continuing glucose-lowering drugs for elective surgery in patients with type 2 diabetes mellitus 

Authors 

• Donal J. Buggy – MOPED Study Chief Investigator

for the Steering Committee:  

Malachy Columb (Manchester University Hospitals Foundation NHS Trust – Wythenshawe, United Kingdom); Jeroen Hermanides (Amsterdam University Medical Center – Amsterdam, the Netherlands); Markus W. Hollman (Amsterdam University Medical Center – Amsterdam, the Netherlands); Mark Coburn (University Hospital Bonn – Bonn Germany); Alexander Zarbock University Hospital Münster – Münster, Germany)