Advances in Perioperative Anesthesia Protocols for Optimizing Glycemic Control in Patients with Type 2 Diabetes: A Systematic Review

ABSTRACT: Patients with type 2 diabetes mellitus (T2DM) undergoing surgery face increased risks of perioperative complications due to glycemic variability. Recent advancements in anesthesia protocols, including continuous glucose monitoring (CGM), individualized insulin delivery, and novel pharmacological agents, have aimed to optimize glycemic control during the perioperative period. This systematic review synthesizes evidence from studies published between 2015 and 2025, evaluating the efficacy, safety, and feasibility of these protocols in T2DM patients. We identified 32 studies through PubMed, Embase, and Cochrane Library searches, focusing on protocols integrating CGM, insulin infusion algorithms, and sodium glucose cotransporter-2 (SGLT2) inhibitors. Findings indicate that CGM-based protocols improve time in target glucose range (80–180 mg/dL) by 15–25% compared to standard care, with reduced rates of postoperative complications. However, challenges such as cost training requirements, and protocol standardization persist. This review highlights the potential of technology driven anesthesia protocols to enhance surgical outcomes in T2DM patients and identifies gaps for future research. Keywords: Type 2 diabetes, perioperative anesthesia, glycemic control, continuous glucose monitoring, insulin therapy, surgical outcomes