SGLT 2 or Sodium Glucose Cotransporter inhibitor
SGLT2 Inhibitors increased recomendation use in patients with Diabetes Mellitus,Heart failure and Chronic kidney disease.
The concern of the patho-physiological changes of patients with SGLT2 inhibitor undergoing surgery in the perioperative period in form of urogenital infections and ketoacidosis is marked
The mechanism of action of SGLT2 is blocking reuptake of Glucose in proximal tubule leads to Glycosuria,increased diuresis ,Hyponatraemia leading to improved renal and cardiovascular outcomes
Drawback observed over time is Euglycemic Ketoacidosis the pathophysiology of which has have been atributed to
Increased Glycosuria --> reduced Insulin-->activation of Free Fatty Acid pathway to generate more glucose leading to increased production of ketone bodies and also increased uptake of ketone bodies in PCT
The incidence of Eu DKA in increased in patients with superceded infection,dehydration,starvation,surgery,pregnancy and alcohol leading to increased morbidity and mortality
The recent guidelines calls to stop the SGLT 2 inhibitors in the peri operative period atleast 72 hours pior to surgery and restart with resumption of oral diet .
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