SummaryIntroductionSodium‐glucose co‐transporter 2 inhibitors are a novel class of antihyperglycaemic drugs used in the management of type 2 diabetes, that improve glycaemic control, cardiovascular outcomes and promote weight loss. They are also approved for the treatment of heart failure and chronic kidney disease in patients with or without diabetes. This narrative review discusses the peri‐operative effects and implications of sodium‐glucose co‐transporter 2 inhibitors and gives an overview of current evidence and existing peri‐operative guidelines.MethodsWe conducted a literature review to identify peer‐reviewed English language articles published since 2000, with further articles identified by reviewing the references of key papers.ResultsPeri‐operative sodium‐glucose cotransporter 2 inhibitor use carries a risk of euglycaemic ketoacidosis. Although clinically significant diabetic ketoacidosis remains a rare event, sodium‐glucose co‐transporter 2 inhibitors inhibitor‐associated diabetic ketoacidosis has been observed across almost all surgical specialities. Ketoacidosis may present with any blood glucose level. Existing guidelines are inconsistent and may be a source of clinical confusion.DiscussionBased on the half‐life of sodium‐glucose cotransporter 2 inhibitors, we recommend withholding treatment for 72 h before elective surgery (5 half‐lives), with additional multidisciplinary input for specific procedures with dietary alterations and in patients with poorly controlled diabetes of cardiac/renal disease. In the event of emergency surgery or any surgery within 72 h of sodium‐glucose cotransporter 2 inhibitor administration, we recommend pre‐, intra‐ and postoperative blood ketone monitoring (6 hourly for 24 h post‐surgery and until full oral diet is resumed). Sodium‐glucose cotransporter 2 inhibitor treatment should only be resumed after resumption of full oral diet in the absence of ketosis.

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钠-葡萄糖协同转运蛋白 2 抑制剂的围手术期意义：叙述性回顾


摘要简介钠-葡萄糖协同转运蛋白 2 抑制剂是一类用于管理 2 型糖尿病的新型降糖药物，可改善血糖控制、心血管结局并促进体重减轻。它们还被批准用于治疗糖尿病患者或非糖尿病患者的心力衰竭和慢性肾病。本叙述性综述讨论了钠-葡萄糖协同转运蛋白 2 抑制剂的围手术期影响和影响，并概述了当前证据和现有围手术期指南。方法我们进行了文献综述，以确定自 2000 年以来发表的同行评审英语文章，并通过审查关键论文的参考文献来确定更多文章。结果围手术期使用钠-葡萄糖协同转运蛋白 2 抑制剂存在血糖正常的酮症酸中毒风险。尽管有临床意义的糖尿病酮症酸中毒仍然是一种罕见事件，但在几乎所有外科专业中都观察到钠-葡萄糖协同转运蛋白 2 抑制剂抑制剂相关的糖尿病酮症酸中毒。酮症酸中毒可能表现为任何血糖水平。现有指南不一致，可能是临床混淆的根源。讨论基于钠-葡萄糖协同转运蛋白 2 抑制剂的半衰期，我们建议在择期手术前 72 小时停止治疗 （5 个半衰期），并为饮食改变的特定手术和心脏/肾脏疾病糖尿病控制不佳的患者提供额外的多学科输入。如果在钠-葡萄糖协同转运蛋白 2 抑制剂给药后 72 小时内进行紧急手术或任何手术，我们建议术前、术中和术后血酮监测（术后 24 小时每 6 小时一次，直到恢复完全口服饮食）。 钠-葡萄糖协同转运蛋白 2 抑制剂治疗只能在无酮症的情况下恢复完全经口饮食后恢复。