Managing the Day-to-Day of SGLT-2 inhibitors – First Do No Harm

A 61-year-old man is undergoing an elective open cholecystectomy. The surgical fellow has phoned you to ask for guidance on his medications perioperatively. In particular, the fellow is uncertain how to proceed with empagliflozin you commenced last month.

Background history includes the following:

  • Type 2 diabetes mellitus
  • Hypertension
  • Morbid obesity (BMI 41kg/m2)
  • Coronary artery disease:
    • Myocardial infarction 2012: PCI to LAD, mild diffuse disease elsewhere
    • Stress test 2019: 8 MET exercise tolerance

Current medications are:

  • Metformin 1g once daily
  • Perindopril 5mg once daily
  • Atorvastatin 80mg once daily
  • Ezetimibe 10mg once daily
  • Aspirin 100mg once daily
  • Empagliflozin 10mg once daily

Labs performed prior to her visit today reveal the following:

  • HbA1c 7.1%
  • eGFR 65mL/min/m2

The surgical fellow tells you that the patient will fast from midnight the night before and anticipates the procedure occurring late morning. He anticipates the patient will be able to commence a light diet the following morning.

What is the most appropriate perioperative guidance for the empagliflozin?

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