Study: SGLT2 inhibitors raise postop euglycemic ketoacidosis risk but lower mortality

Editor's Note

Patients taking SGLT2 inhibitors face a higher risk of postoperative euglycemic ketoacidosis (eKA) but experience fewer acute kidney injuries and deaths after surgery, according to an April 30 article in Medical Xpress.

The article focuses on new research published in JAMA Surgery. Led by researchers at the University of California, San Francisco, the study analyzed data from the Veterans Affairs Healthcare System, focusing on 7,439 adult surgical patients taking SGLT2 inhibitors—which are widely used for type 2 diabetes management—prior to their procedures. These patients were compared with 33,489 matched controls using propensity score matching to account for demographics, comorbidities, and surgical characteristics. As reported by Medical Xpress, the primary finding was an 11% increased risk of perioperative eKA among SGLT2i users, which rose to 18% in the context of emergency surgery.

Despite the elevated eKA risk, patients on SGLT2 inhibitors demonstrated a 31% reduction in postoperative acute kidney injury and a 30% lower 30-day mortality rate compared to non-users. These results suggest that while the metabolic side effects of gliflozins warrant caution, the drugs may offer protective benefits in terms of kidney function and survival outcomes, Medical Xpress reports.

Quoting study authors, the outlet also reports clinicians may need to escalate management strategies, such as insulin administration or continuous dextrose infusion, to address eKA risk—especially since holding the medication before elective surgery does not appear to eliminate the danger. The fact that eKA occurred even in elective procedures highlights the challenge of mitigating this risk through current clinical practices.