[GLP1-agonists and SGLT2 inhibitors in the perioperative setting]

The use of GLP1-agonists and SGLT2 inhibitors among inpatients increases due to their favorable metabolic, cardiovascular, and renal effects. However, there are concerns regarding their perioperative safety, because of delayed gastric emptying associated with GLP1-agonists which potentially increases aspiration risk, and the risk of (euglycemic) ketoacidosis associated with the use of SGLT2 inhibitors. To avoid these potential complications, it is currently advised to stop GLP1-agonists one dose preoperatively and SGLT2 inhibitors for three days, both of which carries a risk for glucose dysregulation. Since the effect of GLP1-agonists on gastric emptying diminishes with long-term use, we argue that GLP1-agonists can be continued. Also, we argue that SGLT2 inhibitors can be safely continued provided that glucose and insulin are administered perioperatively in patients with type 2 diabetes mellitus, with blood gas measurements among those without type 2 diabetes with an increased risk of ketoacidosis.