Sodium-glucose cotransporter-2 inhibitors: an overview and perioperative implications

Curr Opin Anaesthesiol. 2019 Feb;32(1):80-85. doi: 10.1097/ACO.0000000000000674.

Abstract

Purpose of review: Sodium-glucose cotransporter 2 (SGLT-2) inhibitors are a relatively new class of drugs used in the management of diabetes mellitus. This review will highlight key pharmacologic characteristics of this class of drugs; discuss their potential role in management of patients with cardiac disease; and raise several perioperative concerns for anesthesiologists caring for patients on SGLT-2 inhibitors.

Recent findings: Recent trials have shown a strong mortality benefit in diabetic patients on SGLT 2 inhibitors especially in patients with a high cardiovascular burden. In addition, there is a reduction in HbA1c levels, blood pressure, weight and readmissions secondary to heart failure in this patient population. However, these drugs have been also associated with an increased incidence of adverse events, such as euglycemic ketoacidosis, urinary tract infections, acute kidney injury and limb amputations.

Summary: SGLT 2 inhibitors are being increasingly prescribed secondary to their significant salutatory effect in patients with type II diabetes mellitus. Although there are no perioperative consensus guidelines for management of patients on SGLT2 inhibitors, they should be discontinued at least 24-48 h prior to major surgeries. Their overall management in the perioperative period should be carried out on a case-to-case basis using a multidisciplinary approach.

Publication types

  • Review

MeSH terms

  • Acute Kidney Injury / chemically induced
  • Acute Kidney Injury / epidemiology
  • Acute Kidney Injury / prevention & control
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetic Ketoacidosis / chemically induced
  • Diabetic Ketoacidosis / epidemiology
  • Diabetic Ketoacidosis / prevention & control
  • Humans
  • Incidence
  • Patient Safety
  • Perioperative Care / standards*
  • Practice Guidelines as Topic
  • Preoperative Period
  • Sodium-Glucose Transporter 2 Inhibitors / adverse effects*
  • Time Factors
  • Treatment Outcome
  • Urinary Tract Infections / chemically induced
  • Urinary Tract Infections / epidemiology
  • Urinary Tract Infections / prevention & control
  • Withholding Treatment / standards

Substances

  • Sodium-Glucose Transporter 2 Inhibitors