Perioperative and periprocedural management of GLP-1 receptor-based agonists and SGLT2 inhibitors: narrative review and the STOP-GAP and STOP DKA-2 algorithms

📖 Top 30% JournalJan 28, 2025Current medical research and opinion

Managing GLP-1 and SGLT2 diabetes medicines around surgery using the STOP-GAP and STOP DKA-2 guidelines

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Abstract

GLP-1 receptor-based agonists (GLP-1RAs) and SGLT2 inhibitors (SGLT2i) may pose significant perioperative and periprocedural risks.

GLP-1RAs are linked to an increased risk of retained gastric contents.
Pulmonary aspiration is a potential complication associated with GLP-1RA use.
SGLT2 inhibitors may increase the risk of diabetic ketoacidosis during surgical procedures.
Recommendations and algorithms are provided for the safe management of patients using these medications in perioperative settings.

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The GLP-1 receptor-based agonists (GLP-1RAs) and SGLT2 inhibitors (SGLT2i) are major twenty first century breakthroughs in diabetes and obesity medicine but there are important safety considerations regarding the perioperative and periprocedural management of individuals who are treated with these agents. GLP-1RAs have been linked to an increased risk of retained gastric contents and pulmonary aspiration while SGLT2i can be associated with diabetic ketoacidosis. This manuscript provides a narrative review of the available evidence for perioperative and periprocedural risks in people prescribed GLP-1RAs and SGLT2i. The authors provide expert opinion-driven recommendations and algorithms on how to safely manage GLP-1RAs and SGLT2i under perioperative/periprocedural settings.

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