In Reply: Managing noninsulin glucose-lowering medications before surgery

We thank Dr. Kaplan for his interest in our article,¹ and we appreciate his feedback. Both perspectives highlighted by Dr. Kaplan are correct. The recommendations cited in our article reflect the original guidance issued by the American Society of Anesthesiologists (ASA) Taskforce on Preoperative Fasting² (cited in our article as reference 10) about holding glucagon-like peptide (GLP) 1 receptor agonists before a procedure. Also, we cited (as reference 18) another relevant and related guideline from the same ASA Taskforce.³ Dr. Kaplan correctly points out that, subsequent to our submission, the ASA was involved, through a representative (not the Taskforce itself), in issuing a multisociety statement that revised the earlier recommendations about GLP-1 receptor agonists.⁴ Although this statement carries the ASA name, it was not a direct product of the ASA Taskforce.

As acknowledged by us and Dr. Kaplan, recommendations on this topic continue to evolve. Recognizing this and realizing that many other guidelines from different national and international societies had been issued between the time of our submission and final acceptance, at the revision stage we cited (as reference 30) a February 2025 publication on anesthesia for patients with diabetes mellitus that considered all the changing guidelines and formulated practical and pragmatic recommendations.⁵

Our institution’s current anesthesiology guidelines recommend holding weekly injectable GLP-1 receptor agonists 1 week before surgery. We understand that there is still some debate about this practice, and we anticipate that more data will shed light on the best approach. In the meantime, we support this recommendation as a reasonable and cautious strategy.

We appreciate the opportunity to clarify this matter and reinforce the evolving nature of this clinical guidance.

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