SGLT2 Inhibitors Increase the Risk of Diabetic Ketoacidosis Developing in the Community and During Hospital Admission.
J Clin Endocrinol Metab. 2019 Mar 05;:
Authors: Hamblin PS, Wong R, Ekinci EI, Fourlanos S, Shah S, Jones AR, Hare MJL, Calder GL, Epa DS, George EM, Giri R, Kotowicz MA, Kyi M, Lafontaine N, MacIsaac RJ, Nolan BJ, O'Neal DN, Renouf D, Varadarajan S, Wong J, Xu S, Bach LA
CONTEXT: Diabetic ketoacidosis (DKA) has been associated with the use of sodium glucose cotransporter 2 inhibitors (SGLT2i).
OBJECTIVE: To determine the incidence, characteristics and outcomes of DKA in SGLT2i-users vs non-users with type 2 diabetes.
DESIGN: Retrospective, multi-center, controlled cohort study.
SETTING: All public hospitals in Melbourne and Geelong (combined population 5 million), Australia, from 1 September 2015 - 31 October 2017.
PATIENTS: Consecutive cases of DKA that developed in the community, or during the course of hospital admission, in patients with type 2 diabetes.
MAIN OUTCOME MEASURES: In SGLT2i users vs non-users: (i) Odds ratio of DKA developing during hospital admission and (ii) Incidence of DKA.
RESULTS: There were 162 cases of DKA (37 SGLT2i users and 125 non-SGLT2i users) with a physician-adjudicated diagnosis of type 2 diabetes. Of these, DKA developed during the course of inpatient admission in 14 (38%) SGLT2i users vs two (2%) non-SGLT2i users, (odds ratio 37.4 [95% CI 8.0-175.9], p<0.0001). The incidence of diabetic ketoacidosis was 1.02/1000 (95% CI 0.74-1.41/1000) in SGLT2i users vs 0.69/1000 (0.58-0.82/1000) in non-SGLT2i users (odds ratio 1.48 (1.02-2.15), p=0.037). Fifteen SGLT2i users (41%) had peak blood glucose <250 mg/dl (14 mmol/l) compared to one (0.8%) non-SGLT2i user (p<0.001).
CONCLUSIONS: SGLT2i users were more likely to develop DKA as an inpatient compared to non-SGLT2i users. SGLT2i use was associated with a small, but significant increased risk of DKA.
PMID: 30835263 [PubMed - as supplied by publisher]