Perioperative Risks and Outcomes in Asian American Patients with Type 2 Diabetes Mellitus and/or Metabolic Syndrome: a Systematic Scoping Review

Journal of Racial and Ethnic Health Disparities https://doi.org/10.1007/s40615-025-02344-6 Perioperative Risks and Outcomes in Asian American Patients with Type 2 Diabetes Mellitus and/or Metabolic Syndrome: a Systematic Scoping Review Catherine P. Marudo1 · Vikasni Mohan1 · Sanjukta Dutta1 · John M. Reynolds2 Sabrina N. Taldone4 · Eugene S. Fu3 · Aisha Khan3 · Received: 4 September 2024 / Revised: 17 December 2024 / Accepted: 18 February 2025 © The Author(s) 2025 Abstract Asian Americans (AA) have an increased risk of developing type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS) compared to non-Hispanic White Americans, yet over half of AA patients with T2DM are underdiagnosed or untreated. Surgical stress, known to exacerbate hyperglycemia in T2DM, is also associated with increased morbidity and mortality. Thus, AA patients may be at elevated risk of experiencing poor outcomes following surgery. This review aims to summarize the available literature on the perioperative (defined as before, during, and after surgery) risk and outcomes of T2DM in AA surgical patients and identify specific knowledge gaps. A scoping review protocol was developed in accordance with PRISMA guidelines. Medline, Embase, Web of Science, Scopus, and Cochrane CENTRAL were comprehensively searched for publications without language or date limits on perioperative management of undiagnosed and diagnosed T2DM and/ or MetS in AA. Inclusion criteria included full-text studies conducted in the United States (U.S.), specified AA with T2DM and/or MetS as a study population, and focused on perioperative considerations or clinical outcomes. Search results yielded 862 articles imported into Covidence for title, abstracts, full-text screening, and data extraction. Fifteen publications were identified for full review: 13 (86.6%) retrospective cohort study articles, 1 (6.6%) review article, and 1 (6.6%) randomized controlled trial. These articles represented 2,494,987 total patients and 38,440 aggregate Asian American patients (1.5%). Notable findings amongst studies included (1) higher T2DM rates among AA compared to other racial/ethnic groups, (2) diagnosis variations among AA ethnic subgroups, (3) and conflicting findings on postoperative complications in AA. This review highlights knowledge gaps in our current understanding of disparities regarding perioperative risks and outcomes of AA surgical patients with T2DM and/or MetS. There is a need for stronger research methodologies to guide evidence-based recommendations regarding the perioperative risks and optimal management of this patient population. Keywords Type 2 diabetes mellitus · Metabolic syndrome · Asian American Introduction * Eugene S. Fu 1 University of Miami Miller School of Medicine, Miami, FL, USA 2 Louis Calder Memorial Library, University of Miami Miller School of Medicine, Miami, FL, USA 3 Department of Anesthesiology, University of Miami Miller School of Medicine, 1400 NW 12th Ave Suite 4022, Miami, FL 33136, USA 4 Department of Internal Medicine, University of Miami Miller School of Medicine, Miami, FL, USA According to the United States (U.S.) Census Bureau, the population of Asian Americans (AA) nearly doubled between 2000 and 2019 and is projected to surpass 46 million by 2060, making Asian Americans the largest immigrant group by mid-century and the fastest-growing racial or ethnic group in the USA [1, 2] AA are at higher risk of developing type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS) compared to non-Hispanic White Americans (NHW) [3, 4]. However, more than half of AA patients with T2DM are underdiagnosed, putting them at increased potential risk of perioperative complications due to stress hyperglycemia during and after surgery [5]. In AA, Vol.:(0123456789) Journal of Racial and Ethnic Health Disparities T2DM and MetS diagnoses are higher compared to other ethnic and racial groups despite the lower mean body mass index (BMI) in the AA population [3, 4]. The prevalence of T2DM is about 21% among AA, more than twice that in NHW patients [6]. The magnitude of MetS—characterized by truncal obesity, insulin resistance, altered lipid levels, and hypertension—has also been unusually high in East and South Asians compared to NHW patients [7]. The increased risk of T2DM and MetS in AA has been attributed to a combination of physiologic and environmental factors [6, 8]. Major surgical stress induces insulin resistance, resulting in stress hyperglycemia [9]. Perioperative hyperglycemia can lead to immune dysfunction, endothelial dysfunction, coagulopathies, and extended hospital stays following surgery [5]. Impaired prolonged fasting glucose levels are also associated with the development of micro- and macro-vascular complications, which can begin to occur before diagnosis of T2DM and/or MetS [10]. These complications include cardiovascular disease, cerebrovascular disease, retinopathy, neuropathy, and nephropathy [10]. Numerous studies have demonstrated a clear association between perioperative hyperglycemia and T2DM with increased morbidity-related outcomes and increased length of hospital stay [5]. Perioperative risk is higher in patients with undiagnosed T2DM, a diagnosis more common in AA patients [4, 5]. Undiagnosed T2DM is associated with an up to three times increased risk of death and can present significant long-term effects or surgical complications [11]. Patients who develop MetS have a five-fold increased risk of developing T2DM [12]. MetS poses specific perioperative challenges due to its broad definition and varied presentation, including obesity, dyslipidemia, hyperglycemia, insulin resistance, and hypertension [4]. Given increased risk and higher rates of undiagnosed T2DM and/or MetS in AA, this systematic scoping review aims to summarize the available literature on perioperative management of T2DM and perioperative clinical outcomes in AA surgical patients and identify specific knowledge gaps. The objective of this review is to understand how the increased risk of T2DM and MetS in AA patients impacts the perioperative outcomes to better understand the unique needs of AA patients with T2DM and MetS during the perioperative period. By assessing risks and outcomes, clinicians can gain improved insight into the perioperative considerations and management of AA patients undergoing surgical procedures. In this paper, we define perioperative management as the management of AA patients with T2DM and MetS before, during, and after surgery. Perioperative complications include unexpected problems that occur before, during, and after surgery, such as bleeding and wound infections. Perioperative outcomes are defined as the overall result of the surgery, including both expected and unexpected results. These terms were used to understand how assessing risk and outcomes may influence the perioperative considerations and management of diabetes of AA patients with T2DM and MetS. Methods Methodol (...truncated)