Perioperative Management of Glucose-lowering Drugs: Comment

We read with interest the review by Prieser et al. on the perioperative management of oral glucose-lowering agents in patients with type 2 diabetes mellitus.¹  The authors recommend (table 1) that sodium glucose cotransporter–2 inhibitors be ceased 24 h before elective interventions.¹  No allowance is made for the severity of the procedure (minor vs. major surgery) or type of procedure. However, the authors do acknowledge that other sources recommend a longer duration of withholding these medications before elective procedures. Ceasing them just on the day of the procedure may be suitable for minor interventions where early oral intake is possible. For procedures where return to preoperative state is expected to be delayed, some governing bodies recommend withholding these agents more than 24 h. The Australian Diabetes Society (Melbourne, Australia) recommends withholding 2 days before...