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Association Between Diabetes Mellitus and Intraoperative Awareness During General Anesthesia: A Retrospective Cohort Study
Abstract   Open access   Peer reviewed

Association Between Diabetes Mellitus and Intraoperative Awareness During General Anesthesia: A Retrospective Cohort Study

Zhenghao Wang, Ngoc Bich Nguyen and Eduardo Espiridion
International journal of medical students, v 13, S184
31 Dec 2025
url
https://doi.org/10.5195/ijms.2025.3781View
Published, Version of Record (VoR) Open CC BY V4.0

Abstract

diabetes mellitus general anesthesia intraoperative awareness Pharmacokinetics Surgery
Background: Despite advancements in anesthetic techniques, specific patient populations remain vulnerable to intraoperative awareness. Diabetes mellitus (DM), increasingly prevalent and often accompanied by significant comorbidities, may complicate anesthetic management and mask signs of inadequate anesthetic depth. This study investigates whether DM is independently associated with an increased risk of unintended intraoperative awareness. Methods: A retrospective cohort analysis was conducted using the TriNetX research platform, a federated health database. Two cohorts were identified: patients with DM and a control group without DM undergoing surgery under general anesthesia. Propensity-score matching (1:1) was used to control for confounders, including cognitive impairment, chronic obstructive pulmonary disease, substance use, cardiovascular disease, and anesthesia type. The incidence of intraoperative awareness was compared between groups. Results: After matching, 193,868 patients were included in each cohort (total n=387,736). The incidence of intraoperative awareness was significantly higher in the DM group (0.027%, n=52) compared to the non-DM group (0.015%, n=29). DM was associated with a statistically significant increased risk (absolute risk difference: 0.012%, 95% CI: 0.003–0.021%, p=0.0106). Diabetic patients had nearly twice the risk of intraoperative awareness (RR=1.793, 95% CI: 1.139–2.824; OR=1.793, 95% CI: 1.139–2.825). Conclusion: DM significantly increases the risk of intraoperative awareness during general anesthesia. These findings underscore the importance of heightened anesthetic vigilance and personalized monitoring strategies in diabetic patients to mitigate this risk.

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