Association of British Clinical Diabetologists (ABCD) position statement on the risk of diabetic ketoacidosis associated with the use of sodium-glucose cotransporter-2 inhibitors

Dashora, Umesh; Gallagher, Alison; Dhatariya, Ketan; Winocour, Peter; Gregory, Rob

doi:10.15277/bjd.2016.112

Cited by 10 publications

(9 citation statements)

References 34 publications

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“…Retrospective analyses of patients who developed diabetic ketoacidosis while taking an SGLT2 inhibitor revealed circumstances including off-label use in patients with type 1 diabetes mellitus, missed diagnoses of type 1 diabetes mellitus, or latent autoimmune diabetes of adulthood. 6 , 7 …”

Section: Discussionmentioning

confidence: 99%

SGLT2 Inhibitor–Induced Euglycemic Diabetic Ketoacidosis: A Case Report

Wang

Isom

2020

Kidney Medicine

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Euglycemic diabetic ketoacidosis is a rare but serious adverse effect of sodium-glucose cotransporter 2 (SGLT2) inhibitors. We present a case of a woman in her 40s with type 2 diabetes mellitus hospitalized for revascularization for moyamoya disease who developed empagliflozin-associated euglycemic diabetic ketoacidosis despite having stopped the medication before admission. Surgical stress, acute postoperative illness, and decreased carbohydrate intake are postulated to be contributing factors to the development of ketosis in this patient, while near-normal glucose levels initially suggested nondiabetic ketoacidosis physiology and led to delayed diagnosis and treatment. Patients with type 2 diabetes mellitus may develop diabetic ketoacidosis during states of relative insulinopenia, most frequently from inadequate medication or intercurrent illness. During periods of carbohydrate deficiency, volume depletion, and upregulation of counter-regulatory stress hormones, SGLT2 inhibitor therapy can promote lipolysis and ketogenesis while maintaining euglycemia. Clinical considerations to ensure safe SGLT2 inhibitor therapy include appropriate holding parameters, timely diagnosis of euglycemic diabetic ketoacidosis, and recognition that the pharmacologic effects of SGLT2 inhibitor treatment may persist beyond several half-lives of elimination.

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Section: Discussionmentioning

confidence: 99%

SGLT2 Inhibitor–Induced Euglycemic Diabetic Ketoacidosis: A Case Report

Wang

Isom

2020

Kidney Medicine

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“…When a person with diabetes is not well and is unable to eat and drink as normal, some simple rules can prevent further deterioration or DKA. 18 > If ill with diarrhoea, vomiting or fever and unusual drowsiness, stop SGLT2 inhibitors and don't restart until feeling better and eating/drinking fluids normally. > When people with diabetes who take insulin are not able to eat, it may be possible for them to consume half a glass of milk or fruit juice or yogurt or soup (not clear soup) in place of meals and follow individualised advice from their healthcare professionals about what dose of insulin to take.…”

Section: How To Reduce the Risk? Educate The Patient About Sick Day Guidance And Dkamentioning

confidence: 99%

“…It is important to select the right patient for SGLT2 inhibitor therapy and avoid in others who may be at high risk of DKA. 18 The following patients are likely to benefit most. > Adults above 18 years with T2D and one or more of the following:…”

Section: Box 1 Who Is Likely To Benefit Most From Sodium Glucose Co-transporter 2 Inhibitor Treatment?mentioning

confidence: 99%

Association of British Clinical Diabetologists (ABCD) and Diabetes UK joint position statement and recommendations for non-diabetes specialists on the use of sodium glucose co-transporter 2 inhibitors in people with type 2 diabetes (January 2021)

et al. 2021

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Sodium glucose co-transporter 2 (SGLT2) inhibitors are now an established class of medications for the treatment of type 2 diabetes (T2D), no longer reserved for use by specialists in diabetes. They are being used increasingly for their cardiac and renal benefits by primary care, cardiology and renal teams for indications in parallel with diabetes care as part of holistic management. This guidance provides essential information on SGLT therapy, including the main advantages and the important risks of which healthcare professionals should be aware.

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“…61 Thus, there are several organizations that have produced documents highlighting the risk of DKA with the use of these agents. 62–64…”

Section: Cardiovascular Outcomes With a Focus On Glp-1 Agonists And Smentioning

confidence: 99%

“…61 Thus, there are several organizations that have produced documents highlighting the risk of DKA with the use of these agents. [62][63][64] These agents are clearly used far more frequently as shown by the recent prescribing data from the UK. 20,21 What about type 1 diabetes?…”

Section: Cardiovascular Outcomes With a Focus On Glp-1 Agonists And Sglt2 Inhibitorsmentioning

confidence: 99%

Diabetes: the place of new therapies

Dhatariya

2018

Therapeutic Advances in Endocrinology

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Until the discovery of insulin in 1921 there were no effective treatments for diabetes mellitus. After the advent of long-acting insulin, the first oral agents, sulfonylureas became available in the mid-1950s, quickly followed (outside of the United States) by metformin. It was then another three decades before newer agents became available, with alpha glucosidase inhibitors, thiazolidinediones and meglitinides following in the 1990s. Since the turn of the century, several new classes have also been launched. But how do these agents fit into the management of type 2 diabetes? How does one choose which drug class to use after metformin? This review looks at the agents launched since 2000 and how and when they can be used. It also deals with some of the controversies that have arisen and how decisions have changed as a result, in particular moving away from the use of HbA1c as the driver for decision, but rather the cardiovascular safety of these agents and their use in the prevention of premature cardiovascular morbidity and mortality. Now that some of these agents have shown cardiovascular benefit, will this lead to a change in the treatment paradigm?

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Association of British Clinical Diabetologists (ABCD) position statement on the risk of diabetic ketoacidosis associated with the use of sodium-glucose cotransporter-2 inhibitors

Abstract: Br J Diabetes 2016;16:206-209

Cited by 10 publications

References 34 publications

SGLT2 Inhibitor–Induced Euglycemic Diabetic Ketoacidosis: A Case Report

SGLT2 Inhibitor–Induced Euglycemic Diabetic Ketoacidosis: A Case Report

Association of British Clinical Diabetologists (ABCD) and Diabetes UK joint position statement and recommendations for non-diabetes specialists on the use of sodium glucose co-transporter 2 inhibitors in people with type 2 diabetes (January 2021)

Diabetes: the place of new therapies

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