Life-threatening complications for diabetic patients taking SGLT2 inhibitors when undergoing surgery: A poorly recognised problem?

A knowledge of perioperative problems and complications is an important requirement for surgeons. Diabetic patients are a particular group of patients that are specifically at risk of problems. These risks are not only related to the underlying pathophysiological process associated with the disease, but can also occur secondarily to medications used to manage the condition and require careful monitoring, and is of increased importance in the perioperative period. Although a number of medications have historically been used to manage diabetes, a relatively novel group of diabetic medications 'SGLT2 inhibitors' are now being used and have been shown to have many positive attributes, when considering the sequalae of diabetes. However, they have also been associated with significant perioperative problems, which are a consequence of euglycaemic ketoacidosis, a potentially life-threatening condition. Given the significant complications associated with these medications, it is important that practitioners should have an awareness of the problems related to their use. In addition, messages contained in safety releases pertaining to SGLT2 inhibitor use and their risks in patients undergoing surgery, may have been weakened due the timing of their publication in March 2020, during the first UK national lockdown amidst the Coronavirus pandemic.