1130-P: Enhancing Safety-Managing Individuals on SGLT-2 Inhibitors during the Perioperative Period

Introduction & Objective: SGLT-2 inhibitors are crucial for managing diabetes, heart failure, and CKD but increase euglycemic diabetic ketoacidosis (eDKA) risk by altering insulin secretion and glucagon levels, especially during surgical stress and fasting. The FDA recommends holding SGLT-2 inhibitors for 3-4 days before surgery. Our single-center academic medical center has formulated guidelines to mitigate the risk of eDKA in high-risk individuals. Simultaneously, the guidelines strive to avoid cancellations for low-risk cases, particularly when SGLT-2 inhibitors have not been or cannot be discontinued. Methods: A multidisciplinary team consisting of anesthesiology, endocrinology, and pharmacy was convened. A literature review was conducted to identify risk factors for DKA/eDKA to guide algorithm development and a survey was conducted of anesthesia faculty to assess baseline adherence patterns with FDA recommendations and comfort level with diagnosis and treatment of eDKA. Results: In the past 3 months, 55% of anesthesiologists (n=55) canceled a case due to SGLT-2 inhibitor use, and 65% proceeded without holding the SGLT-2 inhibitor. Only 22% felt confident in eDKA management. Consensus recommendations were developed to 1) risk stratify an individual's eDKA risk 2) standardize guidelines for elective and urgent procedures 3) establish robust post-operative monitoring protocols. These steps form a comprehensive framework to enhance perioperative safety in the context of SGLT-2 inhibitor usage. Conclusion: With a multidisciplinary team, we implemented a tailored approach to managing individuals on SGLT-2 inhibitors during surgical procedures, aligning with the local care environment and emphasizing patient safety. Future work should evaluate guideline implementation/adherence and audit clinical practice and assess the effects on institutional rates of case cancellation and eDKA.