Bariatric/metabolic surgery and sodium-glucose cotransporter 2 inhibitors (SGLT2is) are becoming increasingly popular for the management of overweight/obese patients with type 2 diabetes mellitus (T2DM). Consequently, the chance that a patient undergoing bariatric/metabolic surgery is also treated with an SGLT2i would be rather common in clinical practice. Both risks and benefits have been reported. On the one hand, several cases of euglycemic diabetic ketoacidosis have been reported within the few days/weeks after bariatric/metabolic surgery. The causes are diverse but a drastic reduction in caloric (carbohydrate) intake most probably plays a crucial role. Thus, SGLT2is should be stopped a few days (and even more if a pre-operative restricted diet is prescribed to reduce liver volume) before the intervention and reintroduced only when the caloric (carbohydrate) intake is sufficient. On the other hand, SGLT2is may exert a favorable effect to reduce the risk of postprandial hypoglycemia, a complication reported among patients who have been treated with bariatric/metabolic surgery. An increased hepatic glucose production and a reduced production of interleukin-1β have been proposed as possible underlying mechanisms for this protective effect. Finally, whether SGLT2is could prolong diabetes remission following surgery and improve the prognosis of patients with T2DM who benefit from bariatric/metabolic surgery remains to be investigated.

减肥/代谢手术和钠-葡萄糖协同转运蛋白 2 抑制剂 (SGLT2is) 在治疗超重/肥胖 2 型糖尿病 (T2DM) 患者中越来越受欢迎。因此，接受减肥/代谢手术的患者也接受 SGLT2i 治疗的机会在临床实践中相当常见。风险和收益均已报告。一方面，在减肥/代谢手术后几天/几周内报告了几例血糖正常的糖尿病酮症酸中毒病例。原因多种多样，但热量（碳水化合物）摄入量的大幅减少很可能起着至关重要的作用。因此，SGLT2is 应在干预前停止几天（如果术前限制饮食以减少肝脏体积，则应停止几天），并仅在热量（碳水化合物）摄入充足时重新引入。另一方面，SGLT2is 可能对降低餐后低血糖的风险发挥有利作用，餐后低血糖是接受减肥/代谢手术治疗的患者中报告的一种并发症。肝脏葡萄糖产生增加和白细胞介素-1β产生减少被认为是这种保护作用的可能潜在机制。最后，SGLT2is 是否可以延长手术后糖尿病缓解时间并改善受益于减肥/代谢手术的 T2DM 患者的预后仍有待研究。