Euglycemic diabetic ketoacidosis in type 2 diabetes with sodium glucose cotransporter 2 inhibitors

Wang, An Yi; Hou, Sen; Li, Shan Jen; Kao, Wei Fong

doi:10.1016/j.ajem.2016.08.055

Cited by 6 publications

(3 citation statements)

References 6 publications

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“…Early studies evaluating the role of SGLT-2 inhibitors in DM1 patients were soon abandoned after an increased incidence of euglycemic diabetic ketoacidosis was seen, leading to the US Food and Drug Administration warning in 2015. 7 Recent results from the DEPICT-1 trial have shown otherwise, where patients with DM1 treated with dapagliflozin displayed a significant improvement in their HbA1c level with no increased risk of diabetic ketoacidosis compared with the control group. More studies are needed to evaluate the role this medication class in patients with DM1.…”

Section: Discussionmentioning

confidence: 99%

Use of SGLT-2 Inhibitors in Patients With Type 1 Diabetes Mellitus

Hage

Kashyap

Rao

2019

J Prim Care Community Health

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Introduction: Sodium-glucose cotransporter 2 (SGLT-2) inhibitors are the newest class of oral antihyperglycemic medications approved for the treatment of type 2 diabetes mellitus (DM2). Although they are not approved for use in type 1 diabetes mellitus (DM1), SGLT2 inhibitors may help DM1 patients achieve their HbA1c goals by decreasing their insulin requirements, without inducing hypoglycemic episodes and weight gain. Methods: We conducted a retrospective chart review of 26 patients with DM1 treated with off-label SGLT-2 inhibitors. The primary objective was change in HbA1c and weight. The secondary objective was assessing the effect on insulin requirements, blood pressure, and lipid profile. Results: Improvement in HbA1c level was seen in 20 of the 26 patients (77%) after initiation of SGLT-2 inhibitors. The average decrease in HbA1c was 0.32% ( P = .032), with changes seen as early as 1 month posttherapy and maintained with continued SGLT-2 inhibitor use. There was a trend toward weight loss that was not significant. No significant changes in blood pressure or lipid profiles were seen except for a slight increase in low-density lipoprotein ( P = .049). No patient developed euglycemic diabetic ketoacidosis. Three patients discontinued therapy due to uncontrolled genital yeast infections. Conclusion: SGLT-2 inhibitors can be a useful adjunctive therapy in patients with DM1 to improve glycemic control and weight. Although our study did not show any significant changes in the metabolic profile and insulin requirements in these patients, a larger sample size may yield different results.

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Section: Discussionmentioning

confidence: 99%

Use of SGLT-2 Inhibitors in Patients With Type 1 Diabetes Mellitus

Hage

Kashyap

Rao

2019

J Prim Care Community Health

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“…54 Moreover, the link between SGLT2 inhibitors and euglycemic DKA has been discussed in multiple case reports and publications in the past few years. [55][56][57][58] It is speculated that increased renal glucose clearance mediated by use of SLGT2 inhibitors coupled with decreased insulin use to avoid hypoglycemia can lead to lipolysis as the source of energy, and consequently development of euglycemic DKA. 55,56 A phase 1, single-center, double-blind, placebocontrolled, crossover study of 33 patients ages 12 to 21 years with T1DM for ≥12 months stratified the patients by baseline HbA1c to 1 of 2 treatment arms: 10 mg of dapagliflozin (DAPA) or placebo.…”

Section: Non-insulinsmentioning

confidence: 99%

Evolving Pharmacotherapeutic Strategies for Type 1 Diabetes Mellitus

Sabet¹,

Condren²,

Boston³

et al. 2018

The Journal of Pediatric Pharmacology and Therapeutics

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Despite pharmacotherapeutic advancements in the management of type 1 diabetes mellitus during the past several decades, patients struggle to achieve glycemic goals. Additionally, hypoglycemia, especially in extremes of age, decreases quality of life. The lack of optimal glycemic control and risk for hypoglycemia are multifactorial. Nevertheless, endeavors aiming to develop pharmacotherapeutic options with enhanced pharmacokinetic, pharmacodynamic, and clinical profiles continue. This review article discusses recent ventures in 3 categories of insulin, non-insulin, and glucagon products.

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“…Recent case reports suggest an increase in presentations due to increased use of sodium glucose cotransporter-2 (SGLT2) inhibitors. [2][3][4][5][6][7][8][9][10][11] Sodium glucose cotransporter-2 inhibitors work by blocking glucose reabsorption of filtered glucose in the proximal tubule and subsequently lowering serum glucose.…”

Section: Introductionmentioning

confidence: 99%

Euglycemic Diabetic Ketoacidosis in Type 1 Diabetes on Insulin Pump, with Acute Appendicitis: A Case Report

Thompson

Kitchen

2021

Clinical Practice and Cases in Emergency Medicine

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Introduction: Recently, euglycemic diabetic ketoacidosis has been an increasing topic of discussion within emergency medicine literature. Euglycemic diabetic ketoacidosis can easily be missed, as a normal point-of-care glucose often mistakenly precludes the work-up of diabetic ketoacidosis. Case Report: A 16-year-old female with a past medical history of type 1 diabetes presented to the emergency department with altered mental status, vomiting, and abdominal pain. She was diagnosed with euglycemic diabetic ketoacidosis. Conclusion: Reported cases of euglycemic diabetic ketoacidosis are most frequently attributed to sodium glucose cotransporter-2 inhibitors, but other potential causes have been discussed in the literature. In this patient, a starvation state with continued insulin use in the setting of acute appendicitis led to her condition.

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Euglycemic diabetic ketoacidosis in type 2 diabetes with sodium glucose cotransporter 2 inhibitors

Cited by 6 publications

References 6 publications

Use of SGLT-2 Inhibitors in Patients With Type 1 Diabetes Mellitus

Use of SGLT-2 Inhibitors in Patients With Type 1 Diabetes Mellitus

Evolving Pharmacotherapeutic Strategies for Type 1 Diabetes Mellitus

Euglycemic Diabetic Ketoacidosis in Type 1 Diabetes on Insulin Pump, with Acute Appendicitis: A Case Report

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