To the Editor:
I would like to commend Preiser et al. for an excellent review of oral glucose-management drugs in the perioperative period.1 I want to draw attention to a recent U.S. Food and Drug Administration safety labeling change for the management of patients taking sodium glucose cotransporter–2 inhibitor medications that was released after the acceptance of this manuscript for publication. In March 2020, the Food and Drug Administration issued an advisory suggesting that canagliflozin, dapagliflozin, and empagliflozin should all be discontinued 3 days before elective surgery, and ertugliflozin should be discontinued 4 days before elective surgery due to the risk of postoperative euglycemic diabetic ketoacidosis.2 The additional recommended day for discontinuation of ertugliflozin appears to be related to its slightly longer half-life relative to canagliflozin, dapagliflozin, and empagliflozin to ensure appropriate elimination of the medication before the day of surgery. In light of this guidance and existing literature, we believe that it may be appropriate to hold these medications for 3 to 4 days before surgery, especially in patients who may have a prolonged decrease in nutritional intake in the postoperative period.
The author declares no competing interests.