Key result
GLP-1RAs increase residual gastric content (OR 5.96) without raising aspiration risk (OR 1.04), whereas SGLT2 inhibitors increase perioperative euglycemic ketoacidosis risk.
Why the study?
The widespread use of modern antidiabetic therapies such as GLP-1RA, dual GIP/GLP-1 agonists, and SGLT2i introduces increasing perioperative challenges with specific anesthetic and metabolic safety implications in patients with T2DM.
What are the perioperative anesthetic and metabolic safety risks and management strategies for GLP-1 receptor agonists, dual GIP/GLP-1 agonists, and SGLT2 inhibitors in patients with type 2 diabetes mellitus undergoing surgery or procedures under sedation?
What are the perioperative anesthetic and metabolic safety risks and management strategies for GLP-1 receptor agonists, dual GIP/GLP-1 agonists, and SGLT2 inhibitors in patients with type 2 diabetes mellitus undergoing surgery or procedures under sedation?
This narrative review synthesizes perioperative management strategies for patients with type 2 diabetes on GLP-1 receptor agonists, dual GIP/GLP-1 agonists, and SGLT2 inhibitors, emphasizing individualized aspiration risk assessment and preoperative SGLT2 inhibitor discontinuation to prevent euglycemic diabetic ketoacidosis.
Answers are grounded in this paper and cite their sources.
May warrant perioperative caution with GLP-1RAs and SGLT2 inhibitors; leaves open optimal risk-mitigation strategies.
Type 2 diabetes mellitus (T2DM) poses increasing perioperative challenges due to the widespread use of modern antidiabetic therapies with cardiometabolic, renal, and weight-related benefits, but also specific anesthetic and metabolic safety implications. This narrative review integrated clinical, pharmacological, and perioperative evidence on glucagon-like peptide-1 receptor agonists (GLP-1RA), dual GIP/GLP-1 agonists, and sodium-glucose cotransporter-2 inhibitors (SGLT2i). GLP-1RA and dual GIP/GLP-1 agonists are associated with delayed gastric emptying and increased residual gastric content, although their relationship with clinically significant pulmonary aspiration remains uncertain. Gastric ultrasound may support individualized risk stratification in selected settings. Conversely, SGLT2i are linked to euglycemic diabetic ketoacidosis, particularly during fasting, surgery, infection, dehydration, or carbohydrate restriction, requiring preoperative discontinuation, metabolic surveillance, and delayed reinitiation until clinical stability, euvolemia, and oral tolerance are achieved. Perioperative care in T2DM should move beyond a glucose-centered approach and incorporate medication reconciliation, multidisciplinary assessment, and individualized decision-making based on anesthetic, metabolic, and surgical risk.
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Ascanio et al. (2026) conducted a review in Type 2 Diabetes Mellitus in the perioperative setting. GLP-1 receptor agonists, dual GIP/GLP-1 agonists, and SGLT2 inhibitors was evaluated on Perioperative safety including residual gastric content, pulmonary aspiration, and euglycemic diabetic ketoacidosis. GLP-1RAs increase residual gastric content (OR 5.96) without raising aspiration risk (OR 1.04), whereas SGLT2 inhibitors increase perioperative euglycemic ketoacidosis risk.
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