Sodium-glucose co-transporter type-2 inhibitors: pharmacology and peri-operative considerations

Anaesthesia. 2018 Aug;73(8):1008-1018. doi: 10.1111/anae.14251. Epub 2018 Mar 12.

Abstract

Sodium-glucose co-transporter 2 (SGLT2) inhibitors are an emerging class of oral hypoglycaemic agents with therapeutic benefits beyond better glycaemic control. A major concern of the sodium-glucose co-transporter 2 inhibitors is their propensity to cause euglycaemic ketoacidosis in the peri-operative period and the potential for this critical diagnosis to be delayed or missed entirely. This review attempts to collate the case reports of sodium-glucose co-transporter 2 inhibitor ketoacidosis associated with surgery to highlight and put a perspective on this peri-operative issue. Preventive strategies and the management of the ketoacidosis are discussed.

Keywords: diabetic ketoacidosis; sodium-glucose co-transporter 2 (SGLT2) inhibitors.

Publication types

  • Review

MeSH terms

  • Humans
  • Hypoglycemic Agents / adverse effects*
  • Hypoglycemic Agents / pharmacology
  • Hypoglycemic Agents / therapeutic use*
  • Ketosis / chemically induced*
  • Ketosis / epidemiology
  • Ketosis / prevention & control
  • Perioperative Care*
  • Postoperative Complications / chemically induced*
  • Postoperative Complications / epidemiology
  • Postoperative Complications / prevention & control
  • Sodium-Glucose Transporter 2 Inhibitors / adverse effects*
  • Sodium-Glucose Transporter 2 Inhibitors / pharmacology
  • Sodium-Glucose Transporter 2 Inhibitors / therapeutic use*

Substances

  • Hypoglycemic Agents
  • Sodium-Glucose Transporter 2 Inhibitors