JAMA Surg

Pre-op SGLT2 inhibitor use not linked to increased post-op diabetic ketoacidosis

February 26, 2025

Preoperative SGLT2 inhibitor use doesn't significantly increase the risk of postoperative diabetic ketoacidosis (DKA) in patients undergoing emergency surgery. These findings may support reconsideration of current guidelines recommending withholding SGLT2 inhibitor medications 3+ days before surgery, potentially allowing for more liberal use of these medications preoperatively.

Study details: This retrospective cohort study analyzed data from 34,671 patients with T2DM who underwent one of 13 emergency surgeries (e.g., laparoscopic cholecystectomy, transurethral procedures) between January 1, 2016, and December 15, 2022. The study aimed to estimate the association between preoperative SGLT2 inhibitor use and postoperative DKA, defined by diagnosis codes within 14 days post-surgery.

Results: Among the cohort, 7.5% (2,607 patients) used SGLT2 inhibitors preoperatively. Unadjusted incidence of postoperative DKA was 4.9% in the SGLT2 inhibitor group vs. 3.5% in the non–user group. After adjusting for covariates, the incidence was 3.8% for SGLT2 inhibitor users and 3.5% for non-users, with an average treatment effect of 0.2% (95% confidence interval, -1.7% to 2.2%).

Source:

Dixit AA, et al. (2025, February 19). JAMA Surg. Preoperative SGLT2 Inhibitor Use and Postoperative Diabetic Ketoacidosis. https://pubmed.ncbi.nlm.nih.gov/39969891/