Diabetic ketoacidosis in patients treated with SGLT2 inhibitors: experience at a tertiary hospital

Papanastasiou, Labrini; Glycofridi, Spyridoula; Gravvanis, Christos; Skarakis, Nikitas; Papadimitriou, Irene; Kanti, Georgia; Kapsali, Chara; Kounadi, Theodora

doi:10.1007/s42000-020-00256-0

Cited by 6 publications

(5 citation statements)

References 34 publications

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“…In a two-year retrospective study by Papanastasiou1 et al 25 cases of DKA directly related to SGLT-2 inhibitors were analyzed against cases of DKA due to other causes, and they reached important data in our opinion. This study reported no difference in the severity of DKA between the two groups based on the levels of venous blood gas samples.…”

Section: Discussionmentioning

confidence: 97%

The relationship between sodium glucose co-transporter 2 inhibitors and diabetic ketosis/infection: single center retrospective experiences

Tan,

Çifci

2024

ANKMJ

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Aims: Diabetes is a serious social problem in our country and around the world. Beyond hyperglycemia, it causes common and potentially life-threatening complications in all systems. For this reason, beyond the regulation of blood glucose, a holistic approach and combating complications are important in diabetes management. Sodium glucose co-transporter 2 inhibitors (SGLT2-i) are one of many antidiabetic drug families and stand out with their strong blood sugar regulation and cardiac and renal protective effects independent of blood sugar decrease. Despite its strong effectiveness, it is seen as risky in terms of diabetic ketosis and infection, which limits its use. We aimed to investigate the legitimacy of concerns by examining the relationship between SGLT-2 inhibitors and diabetic ketosis/infection. Methods: Our study was designed single-center and retrospectively. 152 patients over the age of 18 who were treated as inpatients in our clinic with diabetic ketosis between January 2020 and June 2023 were included in the study. In these patients, ketosis and the severity of the infection clinic, if any, were examined through various parameters among Type 2 diabetic patients using SGLT-2 inhibitors, Type 2 diabetic patients not using SGLT-2 inhibitors, and Type 1 diabetes patients. These parameters were determined by the patient's blood and urine biochemistry tests at admission and discharge, the duration of ketosis treatment, the duration of intravenous antibiotic use, and the duration of hospitalization. Results: Within the scope of the study, type 2 diabetic patients using SGLT-2 inhibitors were compared with type 2 diabetic patients not using SGLT-2 inhibitors and type 1 diabetic patients. In patients using SGLT-2 inhibitors, the leukocyte in urine, an indicator of urinary tract infection, was found to be significantly higher (p<0.002). When the blood biochemistry tests of the patients at the time of admission were compared in terms of ketosis severity, no significant difference was detected between the groups. No significant difference was detected in terms of ketosis treatment duration, intravenous antibiotic use duration, and hospitalization duration. Conclusion: We believe that we have obtained data showing that ketoacidosis and infection complications associated with SGLT-2 inhibitors are manageable and controllable. Based on this, we recommend that further research be conducted on the side effects of SGLT-2 inhibitors, emphasizing their additional systemic benefits, and that the place of these agents in diabetic treatment should be discussed.

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Section: Discussionmentioning

confidence: 97%

The relationship between sodium glucose co-transporter 2 inhibitors and diabetic ketosis/infection: single center retrospective experiences

Tan,

Çifci

2024

ANKMJ

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“…DKA induced by SGLT-2 inhibitors commonly manifests as euglycemic DKA, [8] entailing augmented fluid intake and a protracted acidosis recovery period. [9] It is imperative to ascertain whether the detected ketonuria in this patient indicated an incipient stage of ketoacidosis. Additionally, the safety of sustaining the patient SGLT-2 inhibitor treatment warrants careful consideration.…”

Section: Discussionmentioning

confidence: 99%

Ketonuria in an adult with Prader-Willi syndrome and diabetes mellitus: A case report

Xu,

Wang,

Pan

et al. 2024

Medicine

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Rationale: Prader-Willi syndrome (PWS) is a genetic disorder affecting multiple systems. Approximately one-quarter of PWS patients will develop diabetes. Given the uncontrolled hyperphagia and resultant severe obesity in these patients, their glycemic management poses a significant challenge. Case report: We present the clinical profile of a male patient diagnosed with both PWS and diabetes. Previous administration of the sodium-glucose co-transporter 2 (SGLT-2) inhibitor Canagliflozin resulted in improved glycemic control and weight management. But at the age of 25, the patient was hospitalized due to worsened glycemic control and the detection of ketonuria. After thorough examination and clinical observation, we discovered that the patient ketonuria was associated with enhanced lipid metabolism related to Canagliflozin. After excluding the risk of SGLT-2 inhibitor-induced euglycemic diabetic ketoacidosis, adjustments of the hypoglycemic regimen, building upon prior treatment, were recommended for the patient. Conclusion: It is important to note that among patients with both PWS and diabetes, the utilization of SGLT-2 inhibitors can lead to the emergence of ketonuria due to increased lipolysis. Therefore, any decision to discontinue SGLT-2 inhibitors should undergo thorough evaluation.

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“…Therefore, in terms of the clinical course, the blood glucose concentration and duration of acidosis differ. SGLT2 inhibitor-associated DKA reportedly yields a lower blood glucose concentration (229 vs. 458.5 mg/dL), longer time to DKA recovery (39 vs. 19 h) and longer insulin administration (41 vs. 21 h) than typical DKA [ 3 , 6 ]. Characteristically, SGLT2 inhibitors can cause euglycaemic DKA, marked by a pH < 7.3, HCO 3 concentration < 18 mEq/L, ketosis and blood glucose concentration < 200 mg/dL, which may lead to a delay in appropriate treatment [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, their use is associated with a higher risk of diabetic ketoacidosis (DKA) [ 2 ]. Additionally, patients with SGLT2 inhibitor-associated DKA may take longer to recover than a typical case of DKA [ 3 ]. Herein, we report a case of SGLT2 inhibitor-associated DKA that worsened during treatment, highlighting the necessity of suspecting SGLT2 inhibitor use when acidosis is prolonged.…”

Section: Introductionmentioning

confidence: 99%

Delayed diagnosis of severe diabetic ketoacidosis associated with a sodium-glucose cotransporter 2 inhibitor: a case report

Taniguchi

Terayama

Seno

et al. 2023

Oxford Medical Case Reports

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Sodium-glucose cotransporter 2 (SGLT2) inhibitors are used to treat patients with type 2 diabetes mellitus but may induce diabetic ketoacidosis (DKA). Owing to their pharmacological mechanisms, they cause a different pathogenesis to that of typical DKA and require special attention in terms of blood glucose concentrations and acidosis. We describe a case of prolonged acidosis because of failure to immediately discover the use of an SGLT2 inhibitor. Compared with typical DKA, SGLT2 inhibitor-associated DKA requires earlier and longer glucose supplementation. SGLT2 inhibitors are specific aetiological factors in DKA, and their use should be suspected when the patient presents with mild hyperglycaemia or prolonged acidosis.

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Diabetic ketoacidosis in patients treated with SGLT2 inhibitors: experience at a tertiary hospital

Cited by 6 publications

References 34 publications

The relationship between sodium glucose co-transporter 2 inhibitors and diabetic ketosis/infection: single center retrospective experiences

The relationship between sodium glucose co-transporter 2 inhibitors and diabetic ketosis/infection: single center retrospective experiences

Ketonuria in an adult with Prader-Willi syndrome and diabetes mellitus: A case report

Delayed diagnosis of severe diabetic ketoacidosis associated with a sodium-glucose cotransporter 2 inhibitor: a case report

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