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Perioperative diabetic management guidelines

February 10, 2020

Perioperative diabetic management is becoming complex. Of particular concern has been the recent introduction of the gliflozin/sodium-glucose transport protein 2 (SGLT2) inhibitor class of medication.

This class of drug has the potential to cause euglycaemic ketoacidosis requiring intensive care admission if not withheld for the appropriate length of time prior to surgery.

Please see the Perioperative Diabetic Medication Guideline that has been developed based on the most recent evidence and through wide consultation. The St Vincent’s Pre-anaesthetic clinic would like you to use this guideline as a reference when you are giving perioperative diabetic medication advice, particularly around the gliflozin/SGLT2 inhibitors.

The ‘take home messages’ from the guideline include:

  • For day surgical procedures excluding colonoscopy, the gliflozins should be withheld on the day of surgery.
  • For colonoscopy and procedures requiring admission to hospital, the gliflozins should with held for 3 days (2 days prior to and including the day of surgery).
  • All other oral hypoglycaemic agents should we withheld on the day of surgery.
  • Long acting insulin should be decreased by 50% prior to surgery.

We hope this guideline aids you in the management perioperative patients.

St Vincents Covering Letter Diabetic Management Guideline