COVID-19 Precipitating Euglycaemic Diabetic Ketoacidosis with SGLT2 Inhibitor Use

Fang, Jianjun; Genco, Matthew; Caskey, Rachel

doi:10.12890/2020_001943

Cited by 6 publications

(5 citation statements)

References 5 publications

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“…Of note, several case series of euglycaemic DKA in patients with T2DM and COVID-19 while on sodium-glucose cotransporter-2 inhibitors (SGLT2is) have been reported ( 51 , 52 ). SGLTis act on glucose and sodium excretion inducing osmotic diuresis and potential dehydration in critically ill patients, especially in a setting of anorexia and vomiting ( 53 ).…”

Section: Glucose Metabolismmentioning

confidence: 99%

Early and late endocrine complications of COVID-19

Kazakou

Paschou

Ψαλτοπούλου

et al. 2021

Endocrine Connections

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Endocrine system plays a vital role in controlling human homeostasis. Understanding possible effects of COVID-19 on endocrine glands is crucial to prevent and manage endocrine disorders before and during hospitalization in COVID-19 infected patients, as well as to follow them up properly upon recovery. Many endocrine glands such as pancreas, hypothalamus and pituitary, thyroid, adrenal glands, testes, and ovaries have been found to express ACE2 receptors, the main binding site of the virus. Since the pandemic outbreak, various publications focus on the aggravation of preexisting endocrine diseases by COVID-19 infection or the adverse prognosis of the disease in endocrine patients. However, data on endocrine disorders, both during the phase of the infection (early complications) and upon recovery (late complications) are scarce. The aim of this review is to identify and discuss early and late endocrine complications of COVID-19. The majority of the available data refer to glucose dysregulation and its reciprocal effect on COVID-19 infection with the main interest focusing on the presentation of new onset of diabetes mellitus. Thyroid dysfunction with either low T3, low TSH or subacute thyroiditis has been reported. Adrenal dysregulation and impaired spermatogenesis in affected men have been also reported. Complications of other endocrine glands are still not clear. Considering the recent onset of COVID-19 infection, the available follow-up data are limited and therefore long-term studies are required to evaluate certain effects of COVID-19 on the endocrine glands.

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Section: Glucose Metabolismmentioning

confidence: 99%

Early and late endocrine complications of COVID-19

Kazakou

Paschou

Ψαλτοπούλου

et al. 2021

Endocrine Connections

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“…With regard to home medications, though majority of the patients in our study did not have a documented history of medication non-compliance, it was seen more significantly in the DKA group when present (OR: 5.69; 95% CI: 1.56-220.7; p<0.01). We must also harbor in mind the risk of euglycemic DKA seen in COVID-19 patients on SGLT2 inhibitors [ 42 , 43 ], though we did not find any similar association. Since the pharmacologic effects of SGLT2 inhibitors can persist for several days, patients can still develop euglycemic DKA even after discontinuation of the drug.…”

Section: Discussionmentioning

confidence: 63%

COVID-19 Related Predisposition to Diabetic Ketoacidosis

Santharaman¹,

Raj²,

Sankaramangalam³

et al. 2023

Cureus

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Background and aimsSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can exacerbate hyperglycemia and can cause life-threatening diabetic ketoacidosis (DKA) in patients with diabetes mellitus (DM). The objective of this study is to compare the characteristics of diabetic COVID-19 patients with and without DKA and to determine the predictors of mortality in the setting of COVID-19 and DKA. MethodsThis is a retrospective single-center cohort study including patients admitted to our hospital with COVID-19 and DM from March 2020 to June 2020. Patients with DKA were filtered as per the diagnostic criteria set by the American Diabetes Association (ADA). Patients with hyperosmolar hyperglycemic state (HHS) were excluded. A retrospective analysis was performed, which included those who developed DKA and those with neither DKA nor HHS. The primary outcome measurement was mortality rate and predictors of mortality for DKA. ResultsOut of 301 patients with COVID-19 and DM, 30 (10%) had DKA and five (1.7%) had HHS. Mortality was significantly higher in the DKA group compared to the non-DKA/HHS group (36.6% vs 19.5%; OR: 2.38; p=0.03). After adjusting for parameters used for multivariate logistic model for mortality, DKA was no longer associated with mortality (OR: 2.08, p=0.35). The independent predictors for mortality were age, platelet count, serum creatinine, C-reactive protein, hypoxic respiratory failure, need for intubation, and need for vasopressors. ConclusionOur study demonstrates higher mortality rate in diabetic COVID-19 patients with DKA. Though direct and independent statistical association of mortality with DKA could not be proven in our multivariate logistic model, physicians must be vigilant in risk-stratifying and managing these patients in a timely manner.

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“…The patients included in the studies were from various countries, including the United States ( n = 3)[ 14 , 18 , 19 ], United Kingdom ( n = 5)[ 15 ], Brazil ( n = 1)[ 16 ], Malaysia ( n = 1)[ 20 ], and Belgium ( n = 2)[ 17 , 21 ]. The reported cases of type 1 diabetes mellitus (T1DM) were observed in the studies conducted in the United Kingdom and Belgium[ 17 , 21 ].…”

Section: Resultsmentioning

confidence: 99%

Sodium-glucose cotransporter-2 inhibitor-associated euglycemic diabetic ketoacidosis in COVID-19-infected patients: A systematic review of case reports

Khedr,

Hennawi,

Khan

et al. 2023

World J Clin Cases

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Alzheimer’s disease (AD) is a progressive and neurodegenerative illness which results in alterations in cognitive development. It is characterized by loss/dysfunction of cholinergic neurons, and formation of amyloid plaques, and formation of neurofibrillary tangles, among other changes, due to hyperphosphorylation of tau-protein. Exposure to pesticides in humans occurs frequently due to contact with contaminated food, water, or particles. Organochlorines, organophosphates, carbamates, pyrethroids and neonicotinoids are associated with the most diagnosed incidents of severe cognitive impairment. The aim of this study was to determine the effects of these pesticides on the phosphorylation of tau protein, and its cognitive implications in the development of AD. It was found that exposure to pesticides increased the phosphorylation of tau protein at sites Ser198, Ser199, Ser202, Thr205, Ser396 and Ser404. Contact with these chemicals altered the enzymatic activities of cyclin-dependent kinase 5 and glycogen synthase kinase 3 beta, and protein phosphatase-2A. Moreover, it altered the expression of the microtubule associated protein tau gene, and changed levels of intracellular calcium. These changes affected tau protein phosphorylation and neuroinflammation, and also increased oxidative stress. In addition, the exposed subjects had poor level of performance in tests that involved evaluation of novelty, as test on verbal, non-verbal, spatial memory, attention, and problem-solving skills.

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COVID-19 Precipitating Euglycaemic Diabetic Ketoacidosis with SGLT2 Inhibitor Use

Cited by 6 publications

References 5 publications

Early and late endocrine complications of COVID-19

Early and late endocrine complications of COVID-19

COVID-19 Related Predisposition to Diabetic Ketoacidosis

Sodium-glucose cotransporter-2 inhibitor-associated euglycemic diabetic ketoacidosis in COVID-19-infected patients: A systematic review of case reports

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