Should GLP-1 Drugs Be Stopped Before Surgery? New Evidence Says Maybe Not.

New large studies challenge previous assumptions about the risk of aspiration when using GLP-1 drugs before surgery. These medications, such as GLP-1 receptor agonists, increase residual gastric contents, but large studies have not associated them with a meaningful increase in aspiration risk. Current guidance increasingly supports continuing GLP-1 therapy in most patients. Individualized risk assessment and gastric ultrasound, when available, are key. In contrast, SGLT2 inhibitors are associated with euglycemic diabetic ketoacidosis, and most guidelines recommend stopping them 3-4 days before surgery. Metformin is supported to be continued in most cases, as there is little evidence linking it to perioperative lactic acidosis. The perioperative significance of DPP-4 inhibitors remains unclear.