Prevalence and Clinical Characteristics of Adults Presenting With Sodium-Glucose Cotransporter-2 Inhibitor-Associated Diabetic Ketoacidosis at a Canadian Academic Tertiary Care Hospital

Clark, Alexa; Mohammed, Arifuddin Saad; Raut, Amol; Moore, Sarah; Houlden, Robyn L.; Awad, Sara

doi:10.1016/j.jcjd.2020.08.100

Cited by 11 publications

(11 citation statements)

References 23 publications

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“…We did not find any previously known precipitator in 22 patients. As discussed by Clark et al, we also think that SGLT2i use could have led to DKA in these patients in the absence of additional triggers 13 . However, there is a possibility of other precipitating factors that could not be assessed in our study.…”

Section: Discussionmentioning

confidence: 59%

“…In this cohort, we found the point prevalence of EuDKA at 58.1% amongst T2D patients within our cohort. Previously a point prevalence of 69.8% for EuDKA in T2D and T1D combined is reported by Clark et al 13 . Our cohort excluded T1D patients because the FDA does not recommend SGLT2i use in this population 16 .…”

Section: Discussionmentioning

confidence: 80%

“…The median length of stay (LOS) in our study varied from 4 to 9 days, depending upon the type of SGLT2i. Variable LOS is reported before, ranging from 3.53 to 6 days 13,17 . The median time to close the anion gap was 2-3 days, based on the type of SGLT2i used, which is almost double compared to the previous 13,17 .…”

Section: Discussionmentioning

confidence: 99%

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SGLT-2 inhibitors associated euglycemic and hyperglycemic DKA in a multicentric cohort

Ata

Yousaf

Khan

et al. 2021

Sci Rep

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Euglycemic diabetic ketoacidosis (EuDKA) secondary to Sodium-glucose co-transporter-2 inhibitors (SGLT2i) in type 2 diabetes mellitus (T2D) is a rare but increasingly reported phenomenon. Not much is known about the burden of EuDKA in patients on SGLT2i or the associated factors. This retrospective cohort study tries to delineate the differences in factors associated with the development of EuDKA as compared to hyperglycemic DKA. We conducted a multicentre, retrospective study across three tertiary care centers under Weill Cornell affiliated-Hamad Medical Corporation, Qatar. The cohort comprised of T2D patients on SGLT2i who developed DKA between January 2015 to December 2020. The differences between the subjects who developed EuDKA or hyperglycaemic DKA (hDKA) were analyzed. A total of 9940 T2D patients were on SGLT2i during 2015–2020, out of which 43 developed DKA (0.43%). 25 developed EuKDA, whereas 18 had hDKA. The point prevalence of EuDKA in our cohort was 58.1%. EuDKA was most common in patients using canagliflozin, followed by empagliflozin and Dapagliflozin (100%, 77%, and 48.3%, respectively). Overall, infection (32.6%) was the most common trigger for DKA, followed by insulin non-compliance (13.7%). Infection was the only risk factor with a significant point estimate between the two groups, being more common in hDKA patients (p-value 0.006, RR 2.53, 95% CI 1.07–5.98). Canagliflozin had the strongest association with the development of EuDKA and was associated with the highest medical intensive care unit (MICU) admission rates (66.6%). In T2D patients on SGLT2i, infection is probably associated with an increased risk of developing EuDKA. The differential role of individual SGLT2i analogs is less clear and will need exploration by more extensive prospective studies.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 80%

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SGLT-2 inhibitors associated euglycemic and hyperglycemic DKA in a multicentric cohort

Ata

Yousaf

Khan

et al. 2021

Sci Rep

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“…SGLT2i are relatively new non-insulin and oral hypoglycemic agents that cause glycosuria by inhibiting the glucose reabsorption in proximal renal tubules. 9 In addition to better glycemic control and cardioprotective effects, there are other metabolic benefits, including improvement of lipids, insulin resistance, nonalcoholic steatohepatitis, and weight associated with the use of SGLT2i. 6 SGLT2i has been a drug of choice for patients with comorbidities like hypertension and obesity because of their favorable effects on the blood pressure and weight/body mass index.…”

Section: Discussionmentioning

confidence: 99%

“…A potentially underdiagnosed adverse effect of SGLT2i use is diabetic ketoacidosis with a reported incidence of less than 0.2% in type 2 and 9.4% in type 1 diabetic patients. 9 We collected data on 16 recently published case reports showing development of diabetes ketoacidosis with and without euglycemia in the patients started on SGLT2i.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Euglycemic diabetic ketoacidosis led by empagliflozin: A case report and literature review

et al. 2022

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Introduction: Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are a new class of medications that have been approved for the treatment of heart failure (HF) in patients with and without type-2 diabetes mellitus. It is important to be aware of the likely side effects of SGLT2i for their optimal use and enhanced patient safety. One such rare but potential side effect is the development of euglycemic diabetic ketoacidosis (EDKA). Objective: We present a case report of EDKA, in a patient who was started on empagliflozin – one of the SGLT2i – highlighting its presenting signs and symptoms, pertinent laboratory findings, differential diagnosis, treatment and outcome. To strengthen our findings and hypothesis, we conducted a literature review of other cases that used SGLT2i and found similar complications. This case report with review can help recognize the serious, potentially life-threatening complications of the new class of medication SGLT2i that has been incorporated into the current practice, and also help to take appropriate steps to mitigate its adverse effects and improve overall health outcomes in our patients. Conclusions: SGLT2i are increasingly used because of their favorable effects on mortality in the chronic HF patients along with its benefits of weight loss and blood pressure reduction. A potential underdiagnosed adverse effect of SGLT2i use is diabetic ketoacidosis in a setting of normal blood glucose levels. Thus, it is reasonable to be cognizant of its side effects to prevent any untoward events in a timely manner.

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SGLT2 inhibitors and euglycemic diabetic ketoacidosis

Yousaf

Ata

Khan

et al. 2021

Eur J Clin Pharmacol

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Prevalence and Clinical Characteristics of Adults Presenting With Sodium-Glucose Cotransporter-2 Inhibitor-Associated Diabetic Ketoacidosis at a Canadian Academic Tertiary Care Hospital

Cited by 11 publications

References 23 publications

SGLT-2 inhibitors associated euglycemic and hyperglycemic DKA in a multicentric cohort

SGLT-2 inhibitors associated euglycemic and hyperglycemic DKA in a multicentric cohort

Case Report: Euglycemic diabetic ketoacidosis led by empagliflozin: A case report and literature review

SGLT2 inhibitors and euglycemic diabetic ketoacidosis

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