SGLT2 inhibitors
The cited ADA 2026 and AHA/ACC 2024 guidance recommends interrupting SGLT2 inhibitors before scheduled surgery: 3 days for canagliflozin, dapagliflozin and empagliflozin, and 4 days for ertugliflozin.
Perioperative ketoacidosis, including euglycaemic ketoacidosis, remains an important concern, particularly in nonelective surgery, prolonged fasting or acute illness. Decisions about restarting treatment depend on clinical recovery, nutritional intake and resolution of ketosis risk.