S1232 No Hospitalizations or Adverse Events Found With SGLT-2 Inhibitor Use and Colonoscopy

Introduction: Sodium-Glucose Cotransporter 2 Inhibitors (SGLT-2i) are commonly prescribed medications that restrict the re-absorption of sodium and glucose in the kidney, leading to an anti-glycemic and diuretic effect. One well-known side effect of SGLT-2is is euglycemic diabetic ketoacidosis (EDKA). Given this, the FDA has advised that patients stop their medication 3-4 days prior to surgery to avoid peri-operative complications. Less is understood about the risk of EDKA around the time of colonoscopy, leading to a lack of societal guidelines on this topic. This retrospective study sought to determine the rate of EDKA in patients taking SGLT-2i undergoing colonoscopy. Methods: A retrospective chart review was conducted at a single academic medical center. A search query was sent through a data analytics software, Qliksense, for all patients taking SGLT-2is who underwent outpatient colonoscopy from 1/1/2024-12/31/2024. Active SGLT-2i use was defined as patients taking an SGLT-2i within 1 month of procedure. Patients who were instructed to hold their SGLT-2i by their gastroenterologist prior to colonoscopy were included in this study. EDKA was defined as hospitalization post-colonoscopy with evidence of ketosis in the serum or urine. Results: There were 138 patients actively taking an SGLT2i who underwent colonoscopy from 1/1/2024 to 12/31/2024. We found that 32% held their SGLT-2i prior to colonoscopy, with about half of patients (51%) holding the medication the day of or the day prior. We found 0 instances of EDKA requiring hospitalization in this patient population. Conclusion: The risk of EDKA in patients undergoing GI procedures and taking SGLT-2i is somewhat disputed in the literature. A case series of 8 patients taking SGLT-2i within 24 hours of colonoscopy were found to have serologic ketosis >1.0 mmol/L. However, a study published a year later sought to establish a standard reference range of ketosis of patients undergoing colonoscopy, and found the upper limit of normal to be 1.7 mmol/L. A larger retrospective study showed a 1% higher rate of DKA in patients taking SGLT-2i compared to controls, although there was no mortality difference whatsoever. Our study found no evidence of EDKA in patients taking SGLT2i and undergoing colonoscopy, independent of if they held the medication or not. Based on limited data available, more research is needed in attempts to unify both gastroenterology and anesthesia guidelines.