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Cited by 56Diabetes Treatment and ManagementCardiac, Anesthesia and Surgical OutcomesHyperglycemia and glycemic control in critically ill and hospitalized patients

Sodium-glucose cotransporter 2 inhibitor-associated perioperative ketoacidosis: a systematic review of case reports

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Seki, Hiroyuki, Ideno, Satoshi, Shiga, Toshiya, Watanabe, Hidenobu, Ono, Motoaki, Motoyasu, Akira, Noguchi, Hikari, Kondo, Kazuya +9 more·2023·Journal of Anesthesia
DOI 10.1007/s00540-023-03174-8PMC PMC10229478
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Abstract

Although the recommended preoperative cessation period for sodium-glucose cotransporter 2 inhibitors (SGLT2is) changed in 2020 (from 24 h to 3–4 days preoperatively) to reduce the risk of SGLT2i-associated perioperative ketoacidosis (SAPKA), the validity of the new recommendation has not been verified. Using case reports, we assessed the new recommendation effectiveness and extrapolated precipitating factors for SAPKA. We searched electronic databases up to June 1, 2022 to assess SAPKA (blood pH < 7.3 and blood or urine ketone positivity within 30 days postoperatively in patients taking SGLT2i). We included 76 publications with 99 cases. The preoperative SGLT2i cessation duration was reported for 59 patients (59.6%). In all cases with available cessation periods, the SGLT2is were interrupted < 3 days preoperatively. No SAPKA cases with > 2-day preoperative cessation periods were found. Many case reports lack important information for estimating precipitating factors, including preoperative SGLT2i cessation period, body mass index, baseline hemoglobin A1c level, details of perioperative fluid management, and type of anesthesia. Our study suggested that preoperative SGLT2i cessation for at least 3 days could prevent SAPKA. Large prospective epidemiologic studies are needed to identify risk factors for SAPKA.

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Sorted by citations

Authors
Seki, H., Ideno, S., Shiga, T., Watanabe, H., Ono, M., Motoyasu, A., Noguchi, H., Kondo, K., Yoshikawa, T., Hoshijima, H., Hyuga, S., Shishii, M., Nagai, A., Higashi, M., Ouchi, T., Yasuda, K., & Kuratani, N.
Affiliations
  • Kyorin University (JP)
  • Kawasaki Municipal Hospital (JP)
  • International University of Health and Welfare (JP)
  • Tohoku University (JP)
  • Kitasato University (JP)
  • Kyushu University (JP)
  • Tokyo Dental College Ichikawa General Hospital (JP)
  • Saitama Children's Medical Center (JP)
Corresponding author
Seki, Hiroyuki
ORCID
Venue
Journal of Anesthesia
Publisher
Springer Science and Business Media LLC
Published
2023-02-27
Volume
37
Issue
3
Pages
465-473
ISSN
  • 0913-8668 (ISSN-L)
  • 1438-8359
DOI
10.1007/s00540-023-03174-8
PMC
PMC10229478
OpenAlex
W4322490198
Cited by
56
References
3
Citations by year
2026: 14 · 2025: 24 · 2024: 16 · 2023: 2
FWCI
2.02
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Anesthesia (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
Japan Society for the Promotion of Science (21K06676)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
Keywords
SGLT2 inhibitors, preoperative drug discontinuation, risk factors, ketone bodies, blood pH, diabetes mellitus, perioperative fluid management, anesthesia type, body mass index, HbA1c
MeSH terms
Sodium-Glucose Transporter 2 Inhibitors, Diabetes Mellitus, Type 2, Glucose, Humans, Ketosis, Prospective Studies, Sodium, Diabetic Ketoacidosis

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