Preoperative SGLT2 Inhibitor Users Have Increased Risk for Postoperative Euglycemic Ketoacidosis

TUESDAY, May 13, 2025 (HealthDay News) — Patients using sodium-glucose cotransporter 2 inhibitors (SGLT2i) preoperatively have a slightly increased risk for postoperative euglycemic ketoacidosis (eKA) but a lower risk for acute kidney injury (AKI) and mortality, according to a study published online April 30 in JAMA Surgery.

Roberta Teixeira Tallarico, M.D., from the University of California, San Francisco, and colleagues examined the risk for postoperative eKA, AKI, and mortality within 30 days after surgery among preoperative long-term SGLT2i users versus nonusers in a multicenter, propensity-matched retrospective case-control study. Adults using SGLT2i preoperatively who underwent inpatient surgical procedures were compared to a propensity score-matched control group in a 1:5 ratio (7,439 users and 33,489 nonusers).

The researchers found that SGLT2i use was associated with an increased risk for eKA (odds ratio, 1.11), but with reduced risks for perioperative AKI and 30-day mortality (odds ratios, 0.69 and 0.70, respectively). Thirty days after surgery, the mortality rate was 1.1 and 1.6 percent among SGLT2i users and nonusers, respectively. The median hospital length of stay increased by three days for those presenting with eKA (median: six versus three days for those with and without eKA).

“The consequences of developing perioperative eKA are not fully understood; however, perioperative eKA may necessitate escalated interventions (i.e., insulin administration or continuous dextrose infusion), which could be associated with an increased risk of prolonged hospitalization or unplanned admission to an intensive care unit,” the authors write.

One author disclosed ties to the pharmaceutical and health care industries.

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