Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/23039
Title: Evolving evidence of diabetic ketoacidosis in patients taking sodium glucose cotransporter 2 inhibitors.
Authors: Fleming, Nicola;Hamblin, Peter Shane;Story, David A;Ekinci, Elif I
Affiliation: Department of Endocrinology & Diabetes, Western Health, Melbourne, Victoria, Australia
Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia
Department of Medicine - Western Precinct, University of Melbourne, St Albans, Victoria, Australia
Department of Medicine, Austin Health, Heidelberg, Victoria, Australia
Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
Centre for Integrated Critical Care, University of Melbourne, Parkville, Victoria, Australia
Issue Date: 17-Apr-2020
EDate: 2020-04-17
Citation: The Journal of clinical endocrinology and metabolism 2020; online first: 17 April
Abstract: Sodium glucose cotransporter 2 inhibitors (SGLT2i) have emerged as an important class of blood glucose lowering medications due to cardiovascular, metabolic and renal benefits. However, there is a small but significant risk of diabetic ketoacidosis (DKA) associated with their use. A literature search was conducted in Ovid MEDLINE and Embase to July 2019 using variants on the key search terms sodium-glucose cotransporter 2, diabetic ketoacidosis and type 2 diabetes. A broad spectrum of evidence was incorporated to facilitate a comprehensive narrative review. Further sources were identified through hand searching of reference lists. Although cardiovascular outcome trials demonstrated mixed evidence of SGLT2i associated DKA, increasing evidence from case reports and cohort studies has identified an increased risk. SGLT2i use is associated with a ketotic state caused by an increased glucagon-insulin ratio and stimulated by factors including stress-induced hormonal changes, insufficient insulin, decreased glucose, increased ketone resorption and hypovolemia. Atypical presentations of DKA with lower than expected blood glucose levels are possible with SGLT2i use, so clinical and biochemical monitoring is vital for early identification and management. DKA risk is particularly increased with precipitating factors, therefore optimization of risk factors is vital. Recommendations for peri-operative and sick day management of patients taking SGLT2i have been suggested based on available evidence. SGLT2i are an excellent class of drug in the physician's toolkit for managing type 2 diabetes. However, both clinicians and patients must be aware of the potential for DKA and the need for increased monitoring, both clinically and biochemically, when potential precipitating factors are present. In acutely unwell patients, these medications should be withheld to reduce the risk of DKA.
URI: http://ahro.austin.org.au/austinjspui/handle/1/23039
DOI: 10.1210/clinem/dgaa200
ORCID: 0000-0002-6479-1310
0000-0003-2372-395X
PubMed URL: 32302001
Type: Journal Article
Subjects: Sodium glucose cotransporter 2 inhibitors
diabetic ketoacidosis
peri-operative
type 2 diabetes
Appears in Collections:Journal articles

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