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Updated: Jun 24, 2025

Improving IV Insulin Administration in a Community Hospital
Published on: June 11, 2012
Risk of perioperative discontinuation of SGLT2 inhibitors
Maartina J P Oosterom-Eijmael1, Jeroen Hermanides2, Daniel H van Raalte3
1Department of Anaesthesiology, Amsterdam University Medical Center, Amsterdam, The Netherlands; Department of Endocrinology and Metabolism, Amsterdam University Medical Center, Amsterdam, The Netherlands; Department of Vascular Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands.
Abstract:
When sodium-glucose cotransporter-2 (SGLT2) inhibitors were primarily prescribed for treatment of diabetes mellitus, guidelines recommended withholding SGLT2 inhibitors before surgery to mitigate the associated risk of ketoacidosis. However, currently, SGLT2 inhibitors are an established therapy for patients with heart failure, and there is evidence that withholding SGLT2 inhibitors can worsen these patients' cardiovascular risk profile. We present an updated risk-benefit analysis of withholding SGLT2 inhibitors before surgery, focusing on patients with heart failure and addressing the risk of ketoacidosis and its treatment in these patients. Clinicians should consider perioperative continuation of SGLT2 inhibitors when prescribed for treatment of heart failure.
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