Protracted glycosuria after discontinuation of sodium‐glucose cotransporter 2 inhibitors: Implications for weekly dosing and extended risk of euglycemic diabetes ketoacidosis

Alhassan, Sharifa; Rudoni, Michael; Alfonso-Jaume, Maria A.; Jaume, Juan Carlos

doi:10.1111/1753-0407.12885

Cited by 5 publications

(5 citation statements)

References 4 publications

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“…The time required to achieve DKA resolution did not differ between the groups. In a second study by the same group, the subcutaneous arm dosed subcutaneous aspart every 1 or every 2 hours and reported no difference in time to DKA resolution across groups [40]. There was low-quality evidence to evaluate the effects of subcutaneous rapid-acting insulin analogues versus IVI on hypoglycemia, with both reporting no significant difference and overall low incidence with <10% of participants in both groups having a glucose <70 mg/dL Of interest, none of these studies employed the use of an intermediate or long-acting basal insulin rapid-acting insulin analog-driven protocol to prevent rebound hyperglycemia and/or ketoacidosis (36).…”

Section: The Role Of Subcutaneous Insulin Use In Dkamentioning

confidence: 99%

“…Management of euDKA includes the same triad approach as classical DKA, but with the clear distinction that dextrose containing fluids are required as an initial step rather than added later as glucose levels decline. The other key management point is that the glycosuria due to SGLT2i can persist for days (40), and fluid resuscitation may need to be extended beyond the stage when the patient is taking normal oral fluid intake.…”

Section: Considerations In the General Management Of Dkamentioning

confidence: 99%

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Diabetic Ketoacidosis in COVID-19: Unique Concerns and Considerations

Palermo

Sadhu

McDonnell

2020

The Journal of Clinical Endocrinology &Amp; Metabolism

107

159

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Abstract Context While individuals with diabetes appear to be at similar risk for SARS-CoV-2 infection to those without diabetes, they are more likely to suffer severe consequences, including death. Diabetic ketoacidosis (DKA) is a common and potentially lethal acute complication of diabetes arising from a relative insulin deficiency, which occurs more often in those with type 1 diabetes and in the setting of moderate to severe illness. Early reports indicate that among patients with pre-existing diabetes, DKA may be a common complication of severe COVID-19 and a poor prognostic sign. Case Description This clinical perspective explores the key elements of caring for individuals with DKA during the COVID-19 pandemic through 2 cases. Topics addressed include diagnosis, triage, and the fundamental principles of treatment with a focus on the importance of characterizing DKA severity and medical complexity to determine the best approach. Conclusions As discussed, some tenets of DKA management may require flexibility in the setting of COVID-19 due to important public health goals, such as preventing transmission to highest risk individuals, reducing healthcare worker exposure to infected patients, and preserving personal protective equipment. Evidence for alternative treatment strategies is explored, with special attention placed on treatment options that may be more relevant during the pandemic, including use of subcutaneous insulin therapy. Finally, DKA is often a preventable condition. We include evidence-based strategies and guidance designed to empower clinicians and patients to avoid this serious complication when possible.

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Section: The Role Of Subcutaneous Insulin Use In Dkamentioning

confidence: 99%

Section: Considerations In the General Management Of Dkamentioning

confidence: 99%

Diabetic Ketoacidosis in COVID-19: Unique Concerns and Considerations

Palermo

Sadhu

McDonnell

2020

The Journal of Clinical Endocrinology &Amp; Metabolism

107

159

View full text Add to dashboard Cite

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“…Treatment includes the same triad approach as DKA, but with the clear distinction that dextrose-containing fluids are needed as an initial step, rather than added later as glucose levels decrease. The other key point in the treatment is that glycosuria can persist for days ( 51 ), requiring prolonged fluid replacement. Therefore, these drugs should be discontinued in case of suspicion or confirmation of COVID-19.…”

Section: Resultsmentioning

confidence: 99%

Diabetic ketoacidosis and COVID-19: what have we learned so far?

Sá-Ferreira

Costa

Guimarães

et al. 2022

American Journal of Physiology-Endocrinology and Metabolism

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Background and aims: In December 2019, a pandemic emerged due to a new coronavirus which imposed various uncertainties and discoveries. It has been reported that diabetes is a risk factor for worst outcomes of COVID-19, and also that SARS-CoV-2 infection was correlated with the occurrence of diabetic ketoacidosis (DKA) in patients. The aim of this work is to discuss this correlation emphasizing the main case reports from 2020 while exploring the management of DKA during the course of COVID-19. Method: Web of Science, PubMed and Scopus databases were searched using two sets of Medical Subject Heading (MeSH) search terms or Title/Abstract words: Coronavirus Infections (Coronavirus Infections, Middle East Respiratory Syndrome, COVID-19) and Diabetic Ketoacidosis (Diabetic Ketoacidosis, Diabetic Acidosis, Diabetic Ketosis). Results: There is a clear correlation between COVID-19 and DKA. The SARS-Cov-2 infection may precipitate both a hyperglycemic state and ketoacidosis occurrence in diabetic and non-diabetic patients, which may lead to fatal outcomes. Conclusion: DKA in patients with COVID-19 may increase risk and worse outcomes. Hence, the SARS-Cov-2 infection presents a new perspective towards the management of glycemia and acidosis in diabetic and non-diabetic patients, highlighting the need for rapid interventions to minimize the complications from COVID-19 while reducing its spreading.

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“…However, diagnosis was initially missed mainly due to the absence of urinalysis at admission. Indeed, the moderate hyperglycemia in euDKA has the deleterious effect of obscuring diagnosis as compared with “traditional DKA” characterized by severe hyperglycemia [2,10,11,12]. This case report differs from previous ones in four aspects that make it original: (1) The differential diagnosis between AKI-related metabolic acidosis and euDKA; in fact, an additional confounder in our patient was the concurrent AKI, although high anion gap acidosis purely related to kidney dysfunction rarely occurs when eGFR >20–25 mL/min/1.73 m 2 and rarely associates with serum bicarbonate <14 mmol/L [13].…”

Section: Discussionmentioning

confidence: 99%

“…This discrepancy indicates a higher incidence of DKA in the real world as compared to the ideal setting of RCT unless renal dysfunction is present. Nevertheless, in clinical practice, this critical event is likely underdiagnosed, and the management still guided by weak evidence and consensus opinion [3,6,7,8,9,10,11].…”

Section: Introductionmentioning

confidence: 99%

Nephrology Consultation for Severe SGLT2 Inhibitor-Induced Ketoacidosis in Type 2 Diabetes: Case Report

Nappi¹,

Verde

Carfora

et al. 2019

Medicina

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Euglycemic diabetic ketoacidosis (euDKA) related to sodium-glucose cotransporter 2 inhibitor (SGLT2-I), despite being reported as consistent, though infrequent, adverse effect in all trials on SGLT2-I in type 2 diabetes mellitus (T2D), still remains poorly known in the real world. On the other hand, the use of this new class of antihyperglycemic agents is expected to increase based on the recent solid evidence of remarkable cardiorenal protection. Therefore, improving awareness on risk factors, diagnosis, and treatment of euDKA is essential to allow correct implementation of SGLT2-I in clinical practice. We here report a T2D patient admitted to the emergency department and then transferred to the nephrology-dialysis unit because of severe euglycemic diabetic ketoacidosis (euDKA) related to sodium-glucose cotransporter 2 inhibitor (SGLT2-I). In our patient, a concurrent acute kidney injury at presentation, initially attributed to excessive use of nonsteroid anti-inflammatory agents, and the absence of severe hyperglycemia led to delayed diagnosis and proper therapy. The detailed description of decision-making process for diagnosis and therapy, and the analysis of precipitating factors as well, discloses the helpful contribution of nephrologist to optimize prevention and management of euDKA.

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Protracted glycosuria after discontinuation of sodium‐glucose cotransporter 2 inhibitors: Implications for weekly dosing and extended risk of euglycemic diabetes ketoacidosis

Cited by 5 publications

References 4 publications

Diabetic Ketoacidosis in COVID-19: Unique Concerns and Considerations

Diabetic Ketoacidosis in COVID-19: Unique Concerns and Considerations

Diabetic ketoacidosis and COVID-19: what have we learned so far?

Nephrology Consultation for Severe SGLT2 Inhibitor-Induced Ketoacidosis in Type 2 Diabetes: Case Report

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