Perioperative management of patients taking sodium-glucose cotransporter 2 inhibitors: Society for Perioperative Assessment and Quality Improvement (SPAQI) multidisciplinary consensus statement.

The perioperative management of patients using sodium-glucose cotransporter 2 inhibitors (SGLT2is) remains controversial. The US Food and Drug Administration currently recommends stopping SGLT2is for 3-4 days before surgery, irrespective of a diagnosis of diabetes mellitus. Other multisociety recommendations vary significantly in terms of SGLT2i management, perioperative monitoring, and mitigating strategies for euglycaemic diabetic ketoacidosis. This multidisciplinary consensus statement led by the Society for Perioperative Assessment and Quality Improvement (SPAQI) provides updated recommendations based on a modified Delphi process and supported by a systematic review of the literature. The recommendations include a tailored approach to management of SGLT2is perioperatively based on the presence of diabetes mellitus and other comorbidities, surgical and periprocedural dietary considerations, as well as monitoring and prevention strategies for euglycaemic diabetic ketoacidosis.