Presentation Details
| Preoperative sodium-glucose transporter-2 inhibitors and postoperative euglycemic diabetic ketoacidosis risk Una E.Choi1, Adriana Oprea2, BobbieJean Sweitzer3, David L.Hepner1. 1Brigham and Women's Hospital, Boston, MA.2Yale School of Medicine, New Haven, CT.3Inova Health System, Fairfax, VA |
Abstract
BACKGROUND: Sodium-glucose transporter-2 inhibitors (SGLT2i) are indicated for type 2 diabetes mellitus (T2DM) and cardiovascular disease management. SGLT2i are associated with euglycemic diabetic ketoacidosis (eDKA). On 3/17/2020, the Food & Drug Administration recommended discontinuing SGLT2i 3-4 days preoperatively. We sought to quantify eDKA risk across surgery types and characterize other postoperative complications.
METHODS: TriNetX Research Network was queried to identify adult surgical patients with T2DM from 01/2005-01/2020 or 01/2005-01/2025 for our emergency surgery analyses. We compared SGLT2i users with other T2DM medications across: all surgeries; non-emergency surgeries defined by no emergency department (ED) visit within 2 days of surgery; emergency surgeries (same day as ED visit, 1 day after ED visit, and 2 days after ED visit), major surgeries like thoracics, cardiac surgeries, colonoscopies, and neurosurgeries. Propensity-score matching was performed for surgery type, age, demographics, hemoglobin A1c, anion gap, glomerular filtration rate, albumin, chronic kidney disease, heart failure (HF), obesity, neoplasms, urinary tract infection, polyneuropathies, stroke, peripheral arterial disease, myocardial infarction, acidosis, health hazards related to socioeconomic and psychosocial circumstances, beta-blockers, diuretics, insulin, and nicotine dependence. We quantified 14-day postoperative eKDA as the outcome of interest and other postoperative outcomes for all surgeries, non-emergency, and emergency surgery analyses.
RESULTS: Compared with other medications, eDKA was higher in SGLT2i users who had emergency surgeries 2 days after ED visits. eDKA rates were not different in the remaining surgeries (Table 1). SGLT2i were associated with lower major adverse cardiovascular events (MACE), HF, and acute kidney injury (AKI) among all surgeries (Table 2).
CONCLUSIONS: Preoperative SGLT2i use was associated with increased 14-day postoperative eDKA in the subgroup having emergency surgeries 2 days after ED presentation. SGLT2i were associated with lower postoperative MACE, HF and AKI in all surgeries and HF and AKI in non-emergency surgeries. A risk-stratified approach should guide perioperative SGLT2i protocols.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
METHODS: TriNetX Research Network was queried to identify adult surgical patients with T2DM from 01/2005-01/2020 or 01/2005-01/2025 for our emergency surgery analyses. We compared SGLT2i users with other T2DM medications across: all surgeries; non-emergency surgeries defined by no emergency department (ED) visit within 2 days of surgery; emergency surgeries (same day as ED visit, 1 day after ED visit, and 2 days after ED visit), major surgeries like thoracics, cardiac surgeries, colonoscopies, and neurosurgeries. Propensity-score matching was performed for surgery type, age, demographics, hemoglobin A1c, anion gap, glomerular filtration rate, albumin, chronic kidney disease, heart failure (HF), obesity, neoplasms, urinary tract infection, polyneuropathies, stroke, peripheral arterial disease, myocardial infarction, acidosis, health hazards related to socioeconomic and psychosocial circumstances, beta-blockers, diuretics, insulin, and nicotine dependence. We quantified 14-day postoperative eKDA as the outcome of interest and other postoperative outcomes for all surgeries, non-emergency, and emergency surgery analyses.
RESULTS: Compared with other medications, eDKA was higher in SGLT2i users who had emergency surgeries 2 days after ED visits. eDKA rates were not different in the remaining surgeries (Table 1). SGLT2i were associated with lower major adverse cardiovascular events (MACE), HF, and acute kidney injury (AKI) among all surgeries (Table 2).
CONCLUSIONS: Preoperative SGLT2i use was associated with increased 14-day postoperative eDKA in the subgroup having emergency surgeries 2 days after ED presentation. SGLT2i were associated with lower postoperative MACE, HF and AKI in all surgeries and HF and AKI in non-emergency surgeries. A risk-stratified approach should guide perioperative SGLT2i protocols.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
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