Beware ketoacidosis with SGLT2 inhibitors in latent autoimmune diabetes.

Abstract

Sodium-glucose co-transporter-2 (SGLT2) inhibitors are increasingly used for the treatment of type 2 diabetes but have been associated with ketoacidosis. We report a case series of three patients with latent autoimmune diabetes who presented with ketoacidosis, including one case with normal blood glucose levels, in the context of SGLT2 inhibitor use. SGLT2 inhibitors should only be used with caution and close clinical monitoring in patients with latent autoimmune diabetes. A clinical risk score permits targeted autoantibody testing and should be undertaken prior to commencement of SGLT2 inhibitors and/or cessation of insulin.