Other oral glucose-lowering medicines
The ADA 2026 recommendation is to hold oral glucose-lowering agents on the day of surgery/procedure, with the SGLT2 exception requiring earlier discontinuation. Drug-specific/local policies may differ.
Agent-specific considerations
- Sulfonylureas (for example gliclazide, glimepiride): hypoglycaemia risk during fasting is the main concern.
- Meglitinides: hypoglycaemia risk is linked to food intake.
- DPP-4 inhibitors: low intrinsic hypoglycaemia risk.
- Thiazolidinediones: fluid retention may be relevant in heart failure.
- Alpha-glucosidase inhibitors: effect depends on food intake.
- Metformin and SGLT2 inhibitors: see their separate references.
Where guidance differs
UK Centre for Perioperative Care guidance makes agent-specific recommendations that differ from a uniform day-of-surgery hold. For example, it permits continuation of some agents with low hypoglycaemia risk. Institutional protocols may follow either approach.
Practical application
- Combination tablets merit a component-by-component review, particularly for an SGLT2 inhibitor.
- The fasting plan includes glucose monitoring and a response to hypo- or hyperglycaemia.
- Resumption is medicine-specific and depends on recovery, nutritional intake, renal function and other relevant factors, including contrast exposure where applicable.
Sources
- ADA Standards of Care in Diabetes—2026, section 16: Diabetes Care in the Hospital
- Centre for Perioperative Care: guideline for perioperative care in diabetes (2023)