Perioperative prevention of euglycaemic diabetic ketoacidosis in people living with type 2 diabetes established on sodium-glucose transport-2 inhibitors – a cross-site multi-cycle audit
Sodium-glucose transport-2 (SGLT2) inhibitors are commonly prescribed for the management of type 2 diabetes mellitus, chronic kidney disease and heart failure. However, their continuation in the perioperative setting in people with diabetes can precipitate euglycaemic diabetic ketoacidosis (EDKA), a...
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| Language: | English |
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Elsevier
2025-09-01
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| Series: | Clinical Medicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1470211825002209 |
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| author | Karl A. Romain Jody Cheng Seung Ho Luka Kim Kenneth Watters Aikaterini Theodoraki |
| author_facet | Karl A. Romain Jody Cheng Seung Ho Luka Kim Kenneth Watters Aikaterini Theodoraki |
| author_sort | Karl A. Romain |
| collection | DOAJ |
| description | Sodium-glucose transport-2 (SGLT2) inhibitors are commonly prescribed for the management of type 2 diabetes mellitus, chronic kidney disease and heart failure. However, their continuation in the perioperative setting in people with diabetes can precipitate euglycaemic diabetic ketoacidosis (EDKA), a potentially life-threatening complication. This multi-cycle audit evaluated adherence to perioperative guidelines regarding preoperative cessation and postoperative re-initiation of SGLT2 inhibitors. Electronic health records of consecutive surgical patients with type 2 diabetes were reviewed over a 6-month period. Two cases of EDKA were identified. Targeted interventions – including staff education and dissemination of guidance – were implemented, followed by re-audit over a 4-month period. Documentation and perioperative SGLT2 inhibitor cessation improved significantly post-intervention; however, postoperative ketone monitoring remained suboptimal, and one further case of EDKA was identified. Since then, capillary blood ketone monitoring has been introduced in clinical areas. These findings add to the body of evidence on the perioperative use of SGLT2 inhibitors. |
| format | Article |
| id | doaj-art-c97930db2f334252ba6e55efc048ed15 |
| institution | Kabale University |
| issn | 1470-2118 |
| language | English |
| publishDate | 2025-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Clinical Medicine |
| spelling | doaj-art-c97930db2f334252ba6e55efc048ed152025-08-23T04:47:47ZengElsevierClinical Medicine1470-21182025-09-0125510050210.1016/j.clinme.2025.100502Perioperative prevention of euglycaemic diabetic ketoacidosis in people living with type 2 diabetes established on sodium-glucose transport-2 inhibitors – a cross-site multi-cycle auditKarl A. Romain0Jody Cheng1Seung Ho Luka Kim2Kenneth Watters3Aikaterini Theodoraki4Department of Diabetes & Endocrinology, Chelsea & Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK; Corresponding author.Imperial College London Faculty of Medicine, Exhibition Road, London SW7 2AZ, UKImperial College London Faculty of Medicine, Exhibition Road, London SW7 2AZ, UKDepartment of Diabetes & Endocrinology, Chelsea & Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UKDepartment of Diabetes & Endocrinology, Chelsea & Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UKSodium-glucose transport-2 (SGLT2) inhibitors are commonly prescribed for the management of type 2 diabetes mellitus, chronic kidney disease and heart failure. However, their continuation in the perioperative setting in people with diabetes can precipitate euglycaemic diabetic ketoacidosis (EDKA), a potentially life-threatening complication. This multi-cycle audit evaluated adherence to perioperative guidelines regarding preoperative cessation and postoperative re-initiation of SGLT2 inhibitors. Electronic health records of consecutive surgical patients with type 2 diabetes were reviewed over a 6-month period. Two cases of EDKA were identified. Targeted interventions – including staff education and dissemination of guidance – were implemented, followed by re-audit over a 4-month period. Documentation and perioperative SGLT2 inhibitor cessation improved significantly post-intervention; however, postoperative ketone monitoring remained suboptimal, and one further case of EDKA was identified. Since then, capillary blood ketone monitoring has been introduced in clinical areas. These findings add to the body of evidence on the perioperative use of SGLT2 inhibitors.http://www.sciencedirect.com/science/article/pii/S1470211825002209SGLT2 inhibitorsPerioperative prescribingPreventing perioperative euglycaemic diabetic ketoacidosis |
| spellingShingle | Karl A. Romain Jody Cheng Seung Ho Luka Kim Kenneth Watters Aikaterini Theodoraki Perioperative prevention of euglycaemic diabetic ketoacidosis in people living with type 2 diabetes established on sodium-glucose transport-2 inhibitors – a cross-site multi-cycle audit Clinical Medicine SGLT2 inhibitors Perioperative prescribing Preventing perioperative euglycaemic diabetic ketoacidosis |
| title | Perioperative prevention of euglycaemic diabetic ketoacidosis in people living with type 2 diabetes established on sodium-glucose transport-2 inhibitors – a cross-site multi-cycle audit |
| title_full | Perioperative prevention of euglycaemic diabetic ketoacidosis in people living with type 2 diabetes established on sodium-glucose transport-2 inhibitors – a cross-site multi-cycle audit |
| title_fullStr | Perioperative prevention of euglycaemic diabetic ketoacidosis in people living with type 2 diabetes established on sodium-glucose transport-2 inhibitors – a cross-site multi-cycle audit |
| title_full_unstemmed | Perioperative prevention of euglycaemic diabetic ketoacidosis in people living with type 2 diabetes established on sodium-glucose transport-2 inhibitors – a cross-site multi-cycle audit |
| title_short | Perioperative prevention of euglycaemic diabetic ketoacidosis in people living with type 2 diabetes established on sodium-glucose transport-2 inhibitors – a cross-site multi-cycle audit |
| title_sort | perioperative prevention of euglycaemic diabetic ketoacidosis in people living with type 2 diabetes established on sodium glucose transport 2 inhibitors a cross site multi cycle audit |
| topic | SGLT2 inhibitors Perioperative prescribing Preventing perioperative euglycaemic diabetic ketoacidosis |
| url | http://www.sciencedirect.com/science/article/pii/S1470211825002209 |
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