New therapeutic agents for type 2 diabetes: anaesthetic considerations. A narrative review

An increasing number of patients treated with novel antidiabetic drugs, including glucagon-like-peptide-1 receptor agonists (GLP-1RA), dual glucose-dependent insulinotropic polypeptide receptor agonists and sodium-glucose cotransporter-2 (SGLT2) inhibitors, are presenting in the perioperative period. GLP-1RAs are known to delay gastric emptying, although current data remain preliminary and somewhat conflicting. SGLT2 inhibitors may be associated with euglycemic ketoacidosis in the perioperative period. To assess residual gastric content, gastric ultrasound may serve as a valuable tool in stratifying aspiration risk. Various recommendations are available for the perioperative management of patients on GLP-1RAs or SGLT2 inhibitors. These are based largely on expert opinion and multi-society consensus. This review aims to summarise the key perioperative considerations related to these drug classes and to familiarise practitioners with their pharmacological profiles. We highlight their potential adverse effects and present current recommendations from professional organisations to support safe and effective perioperative management.