Dental procedures in patients taking sodium-glucose co-transporter 2 (SGLT2) inhibitors

Sodium-glucose co-transporter 2 (SGLT2) inhibitors (eg dapagliflozin, empagliflozin, ertugliflozin) have been associated with the development of euglycaemic diabetic ketoacidosis (DKA) in patients with type 1 or type 2 diabetes. The risk of diabetic ketoacidosis is increased in patients taking SGLT2 inhibitors who:

have been fasting or have a very restricted dietary intake
have undergone a surgical procedure
are dehydrated
have an active infection.

Note: SGLT2 inhibitors may need to be stopped before a dental procedure—consult the medical practitioner.

For prolonged dental procedures, or procedures in which fasting or dehydration is likely either before or after the procedure, consider stopping SGLT2 inhibitors preprocedurally. This must only be done in consultation with the patient’s medical practitioner (see Preprocedural management of noninsulin antihyperglycaemic drugs for adults with type 2 diabetes). Alerts highlighting the periprocedural risk of diabetic ketoacidosis in patients taking an SGLT2 inhibitor have been issued by the Australian Diabetes Society and the Australian Therapeutic Goods Administration.