• Ketan Dhatariya, Nicholas Levy, Kim Russon, Anil Patel, Claire Frank, Omar Mustafa, Philip Newland-Jones, Gerry Rayman, Sarah Tinsley, and Jugdeep Dhesi.
• Elsie Bertram Diabetes Centre, Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK; Norwich Medical School, University of East Anglia, Norwich, UK. Electronic address: Ketan.dhatariya@nnuh.nhs.uk.
• Br J Anaesth. 2024 Apr 1; 132 (4): 639643639-643.

AbstractType 2 diabetes mellitus is an increasingly common long-term condition, and suboptimal perioperative glycaemic control can lead to postoperative harms. The advent of new antidiabetic drugs, in particular glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose cotransporter 2 (SGLT2) inhibitors, has enabled perioperative continuation of these medicines, thus avoiding the harms of variable rate i.v. insulin infusions whilst providing glycaemic control. There are differences between medicines regulatory agencies and organisations on how these classes that are most often used to treat diabetes mellitus, (but also in the case of SGLT2 inhibitors chronic kidney disease and heart failure in those without diabetes) should be managed in the perioperative period. In this commentary, we argue that GLP-1 receptor agonists should continue during the perioperative period and that SGLT2 inhibitors should only be omitted the day prior to a planned procedure . The reasons for the differing advice advocated between regulatory agencies and what anaesthetic practitioners should do in the face of continuing uncertainty are discussed.Copyright © 2024 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

16 keywords...

hide…