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.