Saudi journal of anaesthesiaOct 30, 2026

Guidelines for Managing Diabetes Drugs During Surgery for Anesthesiologists

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗OA ↗

Updated Nov 2, 2026

Abstract

GLP-1 receptor agonists (GLP-1RAs) may not increase the risk of clinically significant aspiration during modern anesthesia practices.

GLP-1RAs are linked to delayed gastric emptying, raising concerns about aspiration risk in surgical settings.
SGLT2 inhibitors have been associated with euglycemic diabetic ketoacidosis (EDKA), especially during surgical stress and fasting.
Recent large-scale outcome data challenge the need for routine preoperative cessation of GLP-1RAs.
Current guidance recommends preoperative discontinuation of SGLT2 inhibitors to reduce EDKA risk.
Anesthesiologists play a key role in managing the balance between metabolic safety and the benefits of these medications.

Simplified

The widespread adoption of glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose linked transporter-2 (SGLT2) inhibitors have substantially improved glycemic control and cardiometabolic outcomes in patients with diabetes and related conditions. However, their increasing perioperative use has introduced important safety considerations for anesthesiologists. GLP-1RAs are associated with delayed gastric emptying, raising concerns regarding aspiration risk, while SGLT2 inhibitors have been linked to euglycemic diabetic ketoacidosis (EDKA), particularly in the context of surgical stress and perioperative fasting. This review synthesizes evolving evidence and international guidance to inform contemporary perioperative management of these agents. For GLP-1RAs, early recommendations advocating routine preoperative cessation have been increasingly challenged by recent large-scale outcome data demonstrating no increase in clinically significant aspiration under modern anesthetic practice, supporting an individualized, risk-based approach with targeted mitigation strategies for higher-risk patients. In contrast, perioperative guidance for SGLT2 inhibitors has converged toward preoperative discontinuation to minimize EDKA risk. The review highlights the central role of anesthesiologists in coordinating multidisciplinary, patient-centered care that balances metabolic safety with preservation of established cardiovascular and renal benefits.

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Guidelines for Managing Diabetes Drugs During Surgery for Anesthesiologists

Abstract

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