Perioperative Management of Sitagliptin for Surgery

Preoperative Recommendations

• The American Diabetes Association recommends continuing sitagliptin until the morning of surgery, with a target HbA1c of less than 8% for elective surgery 1
• The American Diabetes Association recommends verifying HbA1c if it has not been measured in the last 3 months, with a target of less than 8% for elective surgery 1, 2
• The American Diabetes Association recommends suspending metformin on the day of surgery if the patient is taking it in combination 1, 2, 3
• The American Heart Association recommends suspending SGLT2 inhibitors 3-4 days before surgery due to the risk of euglycemic ketoacidosis 1, 4, 5, 6, 7

Intraoperative Management

• The American Diabetes Association recommends monitoring glucose levels every 2-4 hours, with a target range of 100-180 mg/dL 1, 2, 3
• The American Diabetes Association recommends administering rapid-acting insulin as needed to maintain the target glucose range 1, 2, 3

Postoperative Management

• The American Diabetes Association recommends restarting sitagliptin when the patient can tolerate oral medications and glucose levels are between 90-180 mg/dL 2, 3
• The American Diabetes Association recommends continuing glucose monitoring until the patient is stable 2, 3

Special Situations

• The American Society of Anesthesiologists recommends continuing sitagliptin in patients on a very low-calorie diet before bariatric surgery, as it does not cause ketosis like SGLT2 inhibitors 5, 6, 7
• The American Society of Anesthesiologists recommends adjusting other antidiabetic medications as needed in patients on a very low-calorie diet before bariatric surgery 5, 6, 7