Sodium-glucose cotransporter-2 inhibitors (SGLT2i), or gliflozins, are drugs used within the remedy of sort 2 diabetes mellitus (T2DM). They’re designed to decrease excessive blood glucose ranges typical in T2DM, and work by inhibiting the sodium-glucose transport protein 2. SGLT2i have additionally been proven to enhance outcomes amongst sufferers with continual kidney illness, coronary heart failure and coronary artery illness.
These drugs are additionally related to euglycemic ketoacidosis (eKA), which is characterised by excessive ranges of ketones. In wholesome quantities, ketones assist the physique convert fats cells into vitality, however in extra, they’ll make blood acidic and poisonous.
One of many underlying causes for SGLT2i-associated ketoacidosis includes lowered insulin secretion. eKA threat could also be elevated throughout the perioperative interval given the discount in oral carbohydrate consumption throughout this time and the impact of surgical stress, which may enhance insulin necessities and metabolic demand. This elevated threat can also be demonstrated by growing variety of case stories and case collection of sufferers with postoperative eKA related to SGLT2i use. eKA can result in probably extreme penalties if left untreated.
Apparently, medical trials have reported instances of SGLT2i-associated eKA presenting with mildly elevated glucose ranges. To elucidate the affiliation between remedy with SGLT2i and the speed of postoperative eKA, acute kidney harm and mortality after surgical procedure, UCSF researchers have performed a multicenter, retrospective cohort examine to judge the chance of postoperative eKA and secondary medical outcomes, together with acute kidney harm and mortality, amongst SGLT2i customers in comparison with matched non-users.
Within the examine, showing in JAMA Surgical procedure, sufferers handled with SGLT2i had a small however considerably greater threat of postoperative euglycemic ketoacidosis however a decrease threat of postoperative acute kidney harm (AKI) and mortality at 30 days post-surgery.
“The elevated threat of perioperative eKA must be monitored and will necessitate escalated interventions like insulin administration or steady dextrose infusion, which may very well be related to an elevated threat of extended hospitalization or unplanned admission to an intensive care unit,” mentioned examine senior writer Matthieu Legrand, MD, Ph.D., an anesthesiologist and important care medication specialist and UCSF professor of Anesthesia.
Utilizing affected person information from the Veterans Affairs Healthcare System (VAHCS) Nationwide Registry (2014 by 2022), researchers recognized grownup sufferers utilizing SGLT2i pre-operatively who underwent inpatient surgical procedures. These sufferers have been in comparison with a 1-to-5 matched management group utilizing propensity rating matching (PSM), together with the affected person’s demographics, comorbidities and surgical traits.
After PSM, 7,439 sufferers have been recognized as SGLT2i customers and have been in comparison with 33,489 controls. On this multicenter retrospective cohort, the chance of perioperative eKA was 11% greater for sufferers utilizing SGLT2i than their matched counterparts and 18% after emergency surgical procedure, nonetheless, there was a 31% discount in postoperative AKI and a 30% discount in 30-day mortality.
“The elevated threat of eKA was modest, however occurred each after emergency surgical procedure and elective surgical procedure. SGLT2i are often held earlier than elective surgical procedure however this does not seem to keep away from the chance of eKA,” mentioned examine first writer Roberta Teixeira Tallarico, MD, a vital care doctor and UCSF analysis affiliate.
Extra data:
Roberta Teixeira Tallarico et al, Postoperative Outcomes Amongst Sodium-Glucose Cotransporter 2 Inhibitor Customers, JAMA Surgical procedure (2025). DOI: :10.1001/jamasurg.2025.0940. jamanetwork.com/journals/jamas … /fullarticle/2833369
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Diabetes medicine might enhance threat of perioperative ketoacidosis (2025, April 30)
retrieved 30 April 2025
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