Sodium-glucose co-transporter-2 (SGLT2) inhibitors (“gliflozins”) are being used increasingly for the management of of Type 2 Diabetes Mellitus. Acting by promoting urinary glucose excretion, the drugs have been approved as a safe and effective treatment but concerns have been raised about recent reports of patients who developed euglycaemic diabetic ketoacidosis (euDKA) leading to severe acidemia requiring ICU/HDU admission during the perioperative period. The Australian and New Zealand College of Anaesthetists have issued a statement to raise awareness of this issue. Amongst other suggestions the ANZCA have provided guidance that:
- SGLT2i should be ceased up to 3 days pre-operatively or in other physically stressful situations (the two days prior to
surgery and the day of surgery) – other glucose lowering agents may need to be adjusted during this time. - Clinicians should strongly consider postponing non-urgent surgery if SGLT2 inhibitors have not been ceased 3 days prior to surgery,
and blood ketones are >0.6, or where HbA1c is >9.0%, as these are indicators of insulin insufficiency, and a high
risk of DKA. - Blood glucose and ketone levels should be monitored closely in the perioperative period