Use of Single-Dose Dexamethasone in Patients With Diabetes Undergoing Surgery: A Systematic Review and Meta-Analysis

The purpose of this review was to examine the effect of single-dose dexamethasone on perioperative blood glucose in diabetic patients. We used PubMed, Cochrane Library, MEDLINE, CINAHL, Google Scholar, and grey literature for our search. Only randomized controlled trials were included. Risk ratio (RR) and mean difference (MD) were used to estimate outcomes with suitable effect models. Quality of evidence was assessed using the Risk of Bias and GRADE systems. We analyzed seven trials involving 1,321 patients. Diabetic patients treated with single-dose dexamethasone had statistically significant changes in blood glucose levels from baseline by 33.61 mg/dL (MD, 33.61; 95% CI, 17.59 to 49.63; P < .0001). Dexamethasone increased blood glucose levels 1-4 hours (MD, 29.02; 95% CI, 7.09 to 50.94; P = .010), 8-24 hours (MD, 30.81; 95% CI, 9.21 to 52.41; P = .005) after administration and increased risks of hyperglycemia. However, there was no difference in surgical site infection (SSI) (RR, 0.81; 95% CI, 0.59 to 1.11; P = .19). Effect size imprecision, substantial heterogeneity, and publication bias was the study's limitations. We found that single-dose dexamethasone increased glucose concentration 24 hours after surgery with little to no effect on SSI. Extrapolation of these findings to clinical settings must take into consideration the review's limitations.