4CPS-022 Controversies in the preoperative management of SGLT2 inhibitors

<h3>Background and Importance</h3> Sodium-glucose co-transporter type 2 inhibitors (iSGLT2) are increasingly used for glycaemic control. However, diabetic ketoacidosis (DKA) is a serious side effect. To minimise the risk of perioperative DKA, the FDA recommends discontinuing iSGLT2 at least three days before surgery. <h3>Aim and Objectives</h3> The primary objective is to describe glycaemic variations and incidence of DKA in patients treated with ISGLT2 undergoing surgery according to the actual time of drug discontinuation by the patient. Secondary objectives include to analyse adequacy of anaesthesia recommendations and to describe pharmacist interventions in the preoperative management. <h3>Material and Methods</h3> A 4-months prospective intervention study (March-June 2024) was conducted on hospitalised patients undergoing surgery while on iSGLT2 therapy. Patients undergoing outpatient surgery were excluded. The following variables were recorded and a descriptive analysis was carried out. Demographic: age, gender, body mass Index (BMI), and type of iSGLT2. Anaesthesia recommendation: no recommendation, &lt;72-hour, =72-hour (considered adequate recommendation). Pharmaceutical interventions in the preoperative consultation. Real-time of iSGLT2 withdrawal before surgery (detected by the pharmacist at patient admission). Diabetic ketoacidosis and pH. Perioperative glycaemia. <h3>Results</h3> The study included 53 patients, 42 male and 11 female, with a mean age of 75 years and a mean BMI of 27.6. Dapagliflozin was prescribed in 73.6% of cases. In total, 30.2% of patients did not receive the adequate recommendation and 20% did not recall anaesthesia recommendations. The pharmacist ensured patients understanding of the anaesthesia recommendations on chronic drug management before surgery and insisted on the necessity of stopping iSGLT2 72 hours before surgery, achieving an 88.7% compliance rate. 30% of patients exhibited preoperative hyperglycaemia. Six patients did not discontinue the medication, two of whom experienced hypoglycaemia. No significance differences were detected in the levels of glucose in the perioperative period. No cases of DKA were recorded, and all patients maintained normal pH levels. <h3>Conclusion and Relevance</h3> No patients developed DKA, supporting the recommendation of a 72-hour discontinuation period for iSGLT2 before surgery. Pharmacists are integral in ensuring adherence to preoperative medication protocols, enhancing patient understanding and compliance. To address controversies, a pharmacist-led clinical session was conducted to improve hospital protocol adherence for iSGLT2 preoperative management to Anaesthesia and Pharmacy departments. <h3>References and/or Acknowledgements</h3> <h3>Conflict of Interest</h3> No conflict of interest