On March 17, the U.S. Food and Drug Administration (FDA) released a warning about continuing the use of sodium-glucose co-transporter-2 (SGLT-2) inhibitors before surgery. Covered by the European Pharmaceutical Review, the FDA SGLT-2 inhibitor announcement explains that the class of diabetes medications could contribute to a higher risk of ketoacidosis following surgery.

Used to treat type 2 diabetes, the class of SGLT-2 inhibitors includes Invokana (canagliflozin), Farxiga (dapagliflozin), Jardiance (empagliflozin) and Steglatro (ertugliflozin). SGLT-2 inhibitors work to lower the body’s blood sugar by removing it through urination. Although the drug class is FDA approved for treating type 2 diabetes, the medications are proven to treat or prevent diabetic ketoacidosis.

Diabetic ketoacidosis is a condition where the body cannot produce enough energy through the process of breaking down sugars with insulin and instead breaks down fats, creating ketones. If a patient develops diabetic ketoacidosis, they may experience nausea, vomiting, abdominal pain, exhaustion, or trouble with breathing. If they are not treated, the patient may enter a diabetic coma.

According to the FDA SGLT-2 inhibitor announcement, the labeling change that these medications have received occurred due to emerging research that indicates the drugs may put patients at greater risk for developing ketoacidosis after surgery.

In the announcement, the FDA tells patients taking SGLT-2 inhibitors canagliflozin, dapagliflozin, and empagliflozin to discontinue the medication for 72 hours prior to the scheduled surgery. For patients taking the SGLT-2 inhibitor ertugliflozin, patients should cease taking it 96 hours prior to their scheduled surgery. For all of these medications, the FDA recommends resuming treatment of type 2 diabetes with the medication as soon as the risk factors for ketoacidosis have dissipated. 

Patients are advised to never stop taking a medication without consulting with a medical professional to discuss potential repercussions.