Expert Panel Proposes Algorithm for FDG PET Preparation in Diabetics on Newer Medications

Consensus-driven guidance for oncologic FDG PET in diabetics: point-of-care glucose, permissive thresholds, avoid correctional insulin, continue insulin pumps in basal mode. SGLT-2 inhibitors and GLP-1 agonists have limited evidence. Prospective studies needed.

• AJR Expert Panel Narrative Review integrating literature and existing guidelines, given the paucity of systematic studies on optimal FDG PET preparation in diabetics.
• Current guidelines diverge on glucose thresholds, insulin timing, and pump recommendations; evidence is especially sparse for SGLT-2 inhibitors, incretin-based therapies, and automated insulin delivery systems.
• Recommendations are consensus-based and not prospectively validated; the panel calls for studies on medication-specific effects on FDG biodistribution.

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