Preoperative SGLT2 Inhibitor Use for Diabetic Patients Does Not Increase Ketoacidosis

Dixit AA, Bateman BT, Hawn MT, et al. Preoperative SGLT2 Inhibitor Use and Postoperative Diabetic Ketoacidosis. JAMA Surg. 2025; in press

Wagner M, Waljee J. SGLT2 Inhibitors in Perioperative Care-Continue or Hold? JAMA Surg. 2025; in press.

Current recommendations from the US Food and Drug Administration support temporary discontinuation of SGLT2 inhibitors prior to surgery in diabetic patients. Data on association of this practice with postoperative diabetic ketoacidosis are needed.

This study used information from a national database to determine the association of SGLT2 inhibitor use with postoperative diabetic ketoacidosis in a sample (n = 34,671) of diabetic patients who underwent a variety of emergency surgical procedures, with laparoscopic cholecystectomy and urologic procedures being the most common.

Among patients taking SGLT2 inhibitors, postoperative diabetic ketoacidosis was confirmed in 4.9% of patients compared with 3.5% of patients who were not taking the medication. After risk adjustment and matching, the rates were 3.8% and 3.5%, respectively.

The authors concluded that the risk of postoperative diabetic ketoacidosis was not increased in patients taking SGLT2 inhibitors and recommended that guidance for perioperative discontinuation of the drug be liberalized.

In the editorial that accompanied the article, Wagner and Waljee stressed the fact that several confounding factors could alter the conclusions of this study. The results are encouraging but future prospective studies are needed.