Authors: Ahmed SS et al.
Cureus, June 12, 2026.
Summary
This prospective observational study evaluated whether patients with diabetes have more residual gastric contents than patients without diabetes despite following standard preoperative fasting instructions.
Delayed gastric emptying can occur in patients with diabetes because of autonomic neuropathy and altered gastric motility. Consequently, standard fasting duration may not reliably indicate that the stomach is empty. Residual gastric contents increase the risk of regurgitation and pulmonary aspiration during anesthesia.
The study included 122 adults between 30 and 75 years of age who were undergoing elective surgery with general anesthesia. Participants were divided equally into:
• 61 patients without diabetes
• 61 patients with diabetes
All participants fasted for at least eight hours. The average fasting duration was similar between the two groups:
Non-diabetic patients: 8.6 hours
Diabetic patients: 8.8 hours
Before anesthesia, clinicians performed gastric ultrasonography with patients in both the supine and right lateral decubitus positions. The investigators measured the gastric antrum’s craniocaudal and anteroposterior diameters, calculated its cross-sectional area, estimated gastric volume, and assigned a qualitative gastric grade.
Despite nearly identical fasting durations, patients with diabetes had significantly larger gastric antral measurements.
In the supine position, the average gastric antral cross-sectional area was:
Non-diabetic patients: 1.48 cm²
Diabetic patients: 2.27 cm²
In the right lateral decubitus position, the average cross-sectional area was:
Non-diabetic patients: 1.52 cm²
Diabetic patients: 3.34 cm²
Diabetic patients also had a significantly greater estimated gastric volume. The average estimated volume in the diabetic group was 10.3 mL, while patients without diabetes generally had negligible or empty gastric contents.
Qualitative ultrasound findings also differed substantially. A Grade 0 stomach, indicating no visible gastric contents, was found in:
67.2% of non-diabetic patients
9.8% of diabetic patients
Grade 1 findings were present in:
31.1% of non-diabetic patients
83.6% of diabetic patients
The ultrasound findings influenced airway management. Rapid-sequence intubation was performed in:
3.3% of non-diabetic patients
19.7% of diabetic patients
This difference suggests that bedside gastric ultrasound identified patients who appeared adequately fasted but still had sufficient residual gastric contents to alter the anesthetic plan.
What You Should Know
Patients with diabetes may have delayed gastric emptying despite complying with standard fasting instructions.
Fasting duration alone may not accurately determine aspiration risk in diabetic patients.
Preoperative gastric ultrasound can provide objective information about residual gastric contents immediately before anesthesia.
Diabetic patients in this study had significantly larger gastric antral dimensions and more residual gastric contents than non-diabetic patients after similar fasting periods.
A Grade 0 or empty stomach was found in approximately two-thirds of non-diabetic patients but fewer than 10% of diabetic patients.
Rapid-sequence intubation was used approximately six times more frequently in the diabetic group.
Gastric ultrasonography may be particularly valuable when the patient has long-standing diabetes, symptoms of gastroparesis, autonomic neuropathy, poor glycemic control, obesity, uncertain fasting status, or other aspiration risk factors.
The study does not establish that all patients with diabetes require rapid-sequence intubation. Airway management should be individualized using the complete clinical assessment and ultrasound findings.
The study was observational, involved a relatively small population from one institution, and did not report actual aspiration events. Larger multicenter studies are needed to determine whether routine gastric ultrasound reduces pulmonary aspiration or improves clinical outcomes.
Thank you to Cureus for allowing us to summarize this article.