Version 1
: Received: 4 November 2024 / Approved: 4 November 2024 / Online: 5 November 2024 (09:33:55 CET)
How to cite:
Goudra, B.; Green, M. Modern Hypoglycemic Agents and Their Perioperative Implications. Preprints2024, 2024110253. https://doi.org/10.20944/preprints202411.0253.v1
Goudra, B.; Green, M. Modern Hypoglycemic Agents and Their Perioperative Implications. Preprints 2024, 2024110253. https://doi.org/10.20944/preprints202411.0253.v1
Goudra, B.; Green, M. Modern Hypoglycemic Agents and Their Perioperative Implications. Preprints2024, 2024110253. https://doi.org/10.20944/preprints202411.0253.v1
APA Style
Goudra, B., & Green, M. (2024). Modern Hypoglycemic Agents and Their Perioperative Implications. Preprints. https://doi.org/10.20944/preprints202411.0253.v1
Chicago/Turabian Style
Goudra, B. and Michael Green. 2024 "Modern Hypoglycemic Agents and Their Perioperative Implications" Preprints. https://doi.org/10.20944/preprints202411.0253.v1
Abstract
There are far more options to treat diabetes now, than about 15-20 years ago. Among the newer agents, glucagon-like peptide 1 receptor agonists (GLP-1RA), dipeptidyl peptidase-4 inhibitors (DPP-4i) and sodium-glucose cotransporter 2 inhibitors (SGLT-2i), are in common use. While their benefits extend far beyond the management of hyperglycemia, some pose concerns, and challenges to the anesthesia providers. Retained gastric contents due to slow gastric emptying is a significant drawback of GLP-1RA. It benefits the patient in losing weight; however, increases the risk of aspiration and can surprise an unsuspecting anesthesia provider. National associations have issued statements in an effort the mitigate the risk. Recommendations range from withholding of GLP-1RA for a predefined period of time, gastric ultrasound to evaluate the gastric contents and modification of anesthesia management especially with regards to the airway and cancellation of a scheduled (elective) surgery/procedure. SGLT-2i are known to increase the risk of euglycemic ketoacidosis. Duration of preprocedural withholding of SGLT-2i varies with the drug. Use of both GLP-1RA and SGLT-2i extends beyond the treatment of diabetes. While SGLT-2i are being extensively used to treat obesity, they are also used in the management of heart failure. A new insulin formulation of basal insulin that can be administered once weekly to achieve similar blood sugar control as once daily formulation has become available in some countries. Labelled as icodec, this is as yet not approved by the FDA because of severe hypoglycemia concerns. Imeglimin is a variant of metformin with unique mechanisms of action. It is approved for clinical use for type 2 diabetes in Japan and India. Another, as yet investigational product is IcoSema, a once-weekly combination of insulin icodec plus semaglutide. A discussion of all aspects of these drugs is warranted.
Medicine and Pharmacology, Anesthesiology and Pain Medicine
Copyright:
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
