The resumption of sodium-glucose cotransporter-2 (SGLT2) inhibitor therapy following surgical procedures is a critical clinical consideration. These medications, commonly prescribed for glycemic control in patients with diabetes, are typically withheld preoperatively to mitigate the risk of diabetic ketoacidosis (DKA) and dehydration. Determining the optimal timing for restarting SGLT2 inhibitors postoperatively is a nuanced decision that requires careful assessment of individual patient factors.
The importance of correctly managing SGLT2 inhibitors in the perioperative period stems from the potential for serious adverse events. While these drugs offer significant benefits in managing blood sugar and, in some cases, heart failure and chronic kidney disease, their use is associated with an increased risk of euglycemic DKA, a condition characterized by normal or near-normal blood glucose levels despite significant metabolic acidosis. Dehydration and electrolyte imbalances are also potential concerns, especially in the context of surgery and anesthesia. Historically, a lack of standardized guidelines has led to variability in clinical practice regarding the management of these medications around surgical interventions.
