The Effects of Anesthetic Agents on Perioperative Glucose Homeostasis in Patients with Diabetes: A Narrative Review

Anesthesia plays a critical role in modern surgical care by ensuring patient comfort, safety, and physiologic stability. However, the effects of anesthetic agents extend beyond sedation and analgesia and include important, yet often underrecognized, influences on perioperative glucose metabolism. This consideration is particularly relevant in patients with diabetes mellitus, a growing surgical population in whom perioperative hyperglycemia is strongly associated with increased risks of infection, delayed wound healing, cardiovascular complications, and prolonged hospital stay. This narrative review synthesized current clinical and mechanistic evidence regarding how commonly used anesthetic agents and techniques influence perioperative glucose homeostasis. Volatile anesthetics have been shown to impair pancreatic β-cell insulin secretion and promote peripheral insulin resistance through the effect on cellular ion channels, mitochondrial function, and stress hormone pathways, frequently resulting in intraoperative hyperglycemia. In contrast, propofol-based total intravenous anesthesia (TIVA) appears to exert comparatively milder effects on insulin dynamics in many clinical contexts. Adjunctive agents such as dexmedetomidine and clonidine may further stabilize glucose levels through sympatholytic and stress-attenuating mechanisms. Additionally, regional and neuraxial anesthesia consistently demonstrate an ability to blunt the neuroendocrine stress response to surgery, thereby promoting improved glycemic stability. By integrating physiologic mechanisms with clinical findings, this review highlights how anesthetic choice can meaningfully influence perioperative glucose trends. Understanding these interactions is essential for optimizing anesthetic planning, intraoperative monitoring, and glycemic management strategies in diabetic surgical patients.