We thank Dr. Gregory and Thiruvenkatarajan et al. for their positive comments on our review1 and for pointing out the label change by the U.S. Food and Drug Administration (Silver Spring, Maryland), which appeared after our review was accepted for publication. We fully agree that it is appropriate and to be recommended to withhold sodium glucose cotransporter–2 inhibitors 3 to 4 days before surgery to avoid euglycemic diabetic ketoacidosis. Ketoacidosis in people with diabetes is not proportional to the degree of hyperglycemia2 and may be, treacherously, euglycemic in patients taking sodium glucose cotransporter–2 inhibitors. Anesthesiologists should be aware of the risk of this serious complication.
The authors declare no competing interests.