Glucose-Lowering Agents Developed in the Last Two Decades and Their Perioperative Implications
The last two decades have provided far more options f both patients and their physicians in the treatment of diabetes mellitus. While dipeptidyl peptidase-4 inhibitors (DPP-4is) and glucagon-like peptide 1 receptor agonists (GLP-1RAs) have been approved for nearly two decades, sodium–glucose cotrans...
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MDPI AG
2024-12-01
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| author | Basavana Goudra Geno J. Merli Michael Green |
| author_facet | Basavana Goudra Geno J. Merli Michael Green |
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| description | The last two decades have provided far more options f both patients and their physicians in the treatment of diabetes mellitus. While dipeptidyl peptidase-4 inhibitors (DPP-4is) and glucagon-like peptide 1 receptor agonists (GLP-1RAs) have been approved for nearly two decades, sodium–glucose cotransporter 2 inhibitors (SGLT-2is) are relatively new. Of interest to perioperative physicians, these drugs present specific perioperative concerns, prompting many societies to issue guidelines. Retained gastric contents due to slow gastric emptying is a significant drawback of GLP-1RAs, increasing the risk of aspiration. Recommendations include withholding GLP-1RAs for a predefined period of time, performing gastric ultrasound to evaluate gastric contents, modifying anesthesia management, particularly with regard to the airway, or canceling the scheduled (elective) surgery or procedure. SGLT-2is are known to increase the risk of euglycemic ketoacidosis. The benefits of both GLP-1RAs and SGLT-2is extend beyond the treatment of diabetes. As a result, perioperative physicians may encounter their use outside of their traditional indications. SGLT-2is are being used extensively to treat heart failure and obesity, for example. There have been other developments as well. For instance, Imeglimin, a variant of metformin available in Japan and India, Icodec, a once-weekly basal insulin formulation, and IcoSema, a once-weekly combination of Icodec plus semaglutide, are all being explored, although in their early stages or facing approval challenges. |
| format | Article |
| id | doaj-art-4f0c10085f484aeb9f3c856cd877d6a4 |
| institution | Kabale University |
| issn | 1424-8247 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | MDPI AG |
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| spelling | doaj-art-4f0c10085f484aeb9f3c856cd877d6a42025-01-24T13:44:57ZengMDPI AGPharmaceuticals1424-82472024-12-01181410.3390/ph18010004Glucose-Lowering Agents Developed in the Last Two Decades and Their Perioperative ImplicationsBasavana Goudra0Geno J. Merli1Michael Green2Jefferson Surgical Center Endoscopy, Department of Anesthesiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USAJefferson Vascular Center, Division of Vascular Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USADepartment of Anesthesiology and Perioperative Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USAThe last two decades have provided far more options f both patients and their physicians in the treatment of diabetes mellitus. While dipeptidyl peptidase-4 inhibitors (DPP-4is) and glucagon-like peptide 1 receptor agonists (GLP-1RAs) have been approved for nearly two decades, sodium–glucose cotransporter 2 inhibitors (SGLT-2is) are relatively new. Of interest to perioperative physicians, these drugs present specific perioperative concerns, prompting many societies to issue guidelines. Retained gastric contents due to slow gastric emptying is a significant drawback of GLP-1RAs, increasing the risk of aspiration. Recommendations include withholding GLP-1RAs for a predefined period of time, performing gastric ultrasound to evaluate gastric contents, modifying anesthesia management, particularly with regard to the airway, or canceling the scheduled (elective) surgery or procedure. SGLT-2is are known to increase the risk of euglycemic ketoacidosis. The benefits of both GLP-1RAs and SGLT-2is extend beyond the treatment of diabetes. As a result, perioperative physicians may encounter their use outside of their traditional indications. SGLT-2is are being used extensively to treat heart failure and obesity, for example. There have been other developments as well. For instance, Imeglimin, a variant of metformin available in Japan and India, Icodec, a once-weekly basal insulin formulation, and IcoSema, a once-weekly combination of Icodec plus semaglutide, are all being explored, although in their early stages or facing approval challenges.https://www.mdpi.com/1424-8247/18/1/4GLP-1RASGLT-2igliptinsIcodecIcoSemaImeglimin |
| spellingShingle | Basavana Goudra Geno J. Merli Michael Green Glucose-Lowering Agents Developed in the Last Two Decades and Their Perioperative Implications Pharmaceuticals GLP-1RA SGLT-2i gliptins Icodec IcoSema Imeglimin |
| title | Glucose-Lowering Agents Developed in the Last Two Decades and Their Perioperative Implications |
| title_full | Glucose-Lowering Agents Developed in the Last Two Decades and Their Perioperative Implications |
| title_fullStr | Glucose-Lowering Agents Developed in the Last Two Decades and Their Perioperative Implications |
| title_full_unstemmed | Glucose-Lowering Agents Developed in the Last Two Decades and Their Perioperative Implications |
| title_short | Glucose-Lowering Agents Developed in the Last Two Decades and Their Perioperative Implications |
| title_sort | glucose lowering agents developed in the last two decades and their perioperative implications |
| topic | GLP-1RA SGLT-2i gliptins Icodec IcoSema Imeglimin |
| url | https://www.mdpi.com/1424-8247/18/1/4 |
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