Perioperative Management of Glucagon-like Peptide-1 Receptor Agonists and Sodium-Glucose Co-transporter 2 Inhibitors.
The number of patients taking glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose co-transporter 2 (SGLT 2) inhibitors presenting for elective surgery is increasing. Patients taking GLP-1 RAs with the highest risk of aspiration are non-fasters who have recently initiated the drug, have had a recent dose escalation, and/or have active gastrointestinal symptoms. Asymptomatic patients on stable doses of GLP-1 RAs can continue the medication throughout the peri-operative period. SGLT 2 inhibitor use carries a risk of euglycemic diabetic ketoacidosis, particularly in patients on insulin with prolonged fasting and should be held prior to elective procedures.