2026 Southeastern Residency Conference

Impact of GLP-1 and GLP-1/GIP Receptor Agonists on Perioperative Glycemic Control in Arthroplasty

Authors: Julia Sitek, Charles Hartis, Zachary Klick, Minal Patel, Amit Saha, Ashley Talbott, Sarah Kittner, Emily Schaefer 

Objective: Describe the effect of GLP-1 and GLP-1/GIP receptor agonists on perioperative blood glucose levels. 

Background:  
Obesity and type 2 diabetes (T2DM) are well-established risk factors for osteoarthritis, a leading cause of joint degeneration requiring arthroplasty. Both conditions, along with perioperative hyperglycemia, have been associated with worse postprocedural outcomes and increased risk of mortality.  Glucose-like peptide-1 (GLP-1) and GLP-1/glucose-dependent insulinotropic polypeptide receptor agonists (GLP-1/GIP RA) are becoming increasingly popular due to their indications for T2DM and weight management. Perioperative management of GLP-1 and GLP-1/GIP RAs, specifically the optimal holding duration in surgery, remains controversial. Case reports describing intraoperative aspiration events have prompted recommendations to hold these agents before surgery. Conversely, emerging evidence suggests potential benefits of continuing these medications preoperatively, including improved metabolic outcomes. Given their long-half-lives, these agents may continue to confer glycemic benefits even when held; however, withholding them may increase the risk of perioperative hyperglycemia. Therefore, the purpose of this study is to determine the effect of GLP-1 and GLP-1/GIP RAs on perioperative glycemic control in patients undergoing arthroplasty.  

Methods: 
This multicenter, retrospective, cohort study compared the incidence of perioperative hyperglycemia in patients with T2DM with or without a GLP-1 or GLP-1/GIP RA. Patients 18 years and older with T2DM who underwent primary elective total knee or hip arthroplasty and had available preoperative and postoperative blood glucose data were included in this study. Those with type 1 diabetes, an operative diagnosis of periarticular knee or lower extremity fracture, an American Society of Anesthesiologists classification of 4 or higher, or a need for general anesthesia were excluded. The primary outcome was the percentage of patients with preoperative and postoperative blood glucose levels of 180 mg/dL or greater. Secondary outcomes include any incidence of a hyperglycemic event during admission, 30-day incidence of prosthetics joint infections (PJI) and surgical site infections, incidence of aspiration or regurgitation during procedure, postoperative nausea and vomiting, and 30-day all-cause mortality. Data collection includes baseline demographics, hospitalization characteristics, and drug characteristics, specifically the agent, dose, and time withheld before surgery. Descriptive statistics were used to summarize the incidence of the primary outcome. Inferential statistics were analyzed using Student-t tests for continuous endpoints and Chi-square tests for categorical endpoints. 

Preliminary Results: Among patients undergoing total knee or hip arthroplasty across five hospitals between March 2, 2024 and September 1, 2025, 104 patients were included in the analysis. The cohort was 53.8% female with a mean age of 69 years, mean A1c of 6.5%, and mean BMI of 32.65 kg/m². Preoperatively, 42.3% were on a GLP‑1 or GLP‑1/GIP RA preoperatively. The primary outcome occurred in one (2.3%) patient on a GLP‑1 RA and one (1.7%) patient not receiving a GLP‑1 or GLP‑1/GIP RA preoperatively [OR of 1.37 (95% CI : 0.08 – 22.55, P-Value 0.82)]. The secondary outcome of any event of hyperglycemia during admission occurred in 19 (43.2%) patients receiving a GLP‑1 or GLP-1/GIP RA and 24 (40%) patients not receiving a GLP‑1 or GLP‑1/GIP RA [OR 1.14 ( 95% CI : 0.51 – 2.51, P- Value 0.74)]. Among GLP‑1 or GLP‑1/GIP RA users, the mean duration of medication hold prior to surgery was 10 days. No patients experienced a surgical site infection, PJI, or aspiration/regurgitation event during the study period.  

Conclusion: Holding GLP-1 or GLP-1/GIP RAs for elective total knee or hip arthroplasties does not affect perioperative glycemic control. The benefit of holding GLP-1 or GLP-1/GIP RAs for primary elective arthroplasty may outweigh the risk as no statistically significant increase in incidence of hyperglycemia was observed.