Diabetic ketoacidosis in patients with type 2 diabetes on sodium-glucose cotransporter-2 inhibitors - A case series

Purva V. Sharma, Yash B. Jobanputra, Karen Lewin, Stuart Bagatell, Daniel Lichtstein

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Diabetic ketoacidosis (DKA) is a serious complication of diabetes seen commonly in autoimmune Type 1 diabetes mellitus (DM), however patients with Type 2 diabetes are also at risk. Diabetic ketoacidosis may be precipitated by the catabolic stress of acute illness such as trauma, surgery, or infections. Recent studies have suggested that sodium-glucose cotransporter-2 (SGLT-2) inhibitors precipitate DKA in Type 2 diabetes. We present a case series of four patients on SGLT-2 inhibitors who presented with DKA. Methods: Medical records were reviewed and patients who were admitted with diabetic ketoacidosis in the last one year at our institute were identified. The charts of such patients were reviewed and we were able to identify 4 patients who were admitted with DKA and were on SGLT-2 inhibitors at the time of admission for the management of their diabetes. Results: The age group of the four patients was between 45-65 years. Interestingly, all four patients were female. The admission blood glucose levels of these patients ranged from 203 to 400(mg/dl). The pH at the time of admission was in the acidotic range with anion gap ranging from 19 to 24. Two of these four patients had symptoms of a localized infection at the time of admission, which was confirmed by laboratory and radiological evaluation. Three of these patients required management in the intensive care unit. Conclusion: Ketoacidosis is a rare but serious side effect of SGLT2 inhibitors. It is being increasingly reported as these drugs are now commonly being prescribed in the primary care setting. Awareness that DKA can occur in the setting of relative euglycemia is critical to recognize this life-threatening complication of diabetes. More research is needed to better understand the underlying pathophysiology and precipitating factors leading to ketoacidosis in SGLT-2 inhibitor treated patients.

Original languageEnglish (US)
Pages (from-to)156-160
Number of pages5
JournalReviews on Recent Clinical Trials
Volume13
Issue number2
DOIs
StatePublished - Jan 1 2018
Externally publishedYes

Fingerprint

Sodium-Glucose Transport Proteins
Diabetic Ketoacidosis
Type 2 Diabetes Mellitus
Ketosis
Diabetes Complications
Time Management
Precipitating Factors
Acid-Base Equilibrium
Infection
Type 1 Diabetes Mellitus
Medical Records
Intensive Care Units
Blood Glucose

Keywords

  • Canagliflozin
  • Diabetes mellitus
  • Diabetic ketoacidosis
  • Empagliflozin
  • SGLT-2 inhibitors
  • Type 2 diabetes

ASJC Scopus subject areas

  • Pharmacology

Cite this

Diabetic ketoacidosis in patients with type 2 diabetes on sodium-glucose cotransporter-2 inhibitors - A case series. / Sharma, Purva V.; Jobanputra, Yash B.; Lewin, Karen; Bagatell, Stuart; Lichtstein, Daniel.

In: Reviews on Recent Clinical Trials, Vol. 13, No. 2, 01.01.2018, p. 156-160.

Research output: Contribution to journalArticle

Sharma, Purva V. ; Jobanputra, Yash B. ; Lewin, Karen ; Bagatell, Stuart ; Lichtstein, Daniel. / Diabetic ketoacidosis in patients with type 2 diabetes on sodium-glucose cotransporter-2 inhibitors - A case series. In: Reviews on Recent Clinical Trials. 2018 ; Vol. 13, No. 2. pp. 156-160.
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abstract = "Background: Diabetic ketoacidosis (DKA) is a serious complication of diabetes seen commonly in autoimmune Type 1 diabetes mellitus (DM), however patients with Type 2 diabetes are also at risk. Diabetic ketoacidosis may be precipitated by the catabolic stress of acute illness such as trauma, surgery, or infections. Recent studies have suggested that sodium-glucose cotransporter-2 (SGLT-2) inhibitors precipitate DKA in Type 2 diabetes. We present a case series of four patients on SGLT-2 inhibitors who presented with DKA. Methods: Medical records were reviewed and patients who were admitted with diabetic ketoacidosis in the last one year at our institute were identified. The charts of such patients were reviewed and we were able to identify 4 patients who were admitted with DKA and were on SGLT-2 inhibitors at the time of admission for the management of their diabetes. Results: The age group of the four patients was between 45-65 years. Interestingly, all four patients were female. The admission blood glucose levels of these patients ranged from 203 to 400(mg/dl). The pH at the time of admission was in the acidotic range with anion gap ranging from 19 to 24. Two of these four patients had symptoms of a localized infection at the time of admission, which was confirmed by laboratory and radiological evaluation. Three of these patients required management in the intensive care unit. Conclusion: Ketoacidosis is a rare but serious side effect of SGLT2 inhibitors. It is being increasingly reported as these drugs are now commonly being prescribed in the primary care setting. Awareness that DKA can occur in the setting of relative euglycemia is critical to recognize this life-threatening complication of diabetes. More research is needed to better understand the underlying pathophysiology and precipitating factors leading to ketoacidosis in SGLT-2 inhibitor treated patients.",
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AB - Background: Diabetic ketoacidosis (DKA) is a serious complication of diabetes seen commonly in autoimmune Type 1 diabetes mellitus (DM), however patients with Type 2 diabetes are also at risk. Diabetic ketoacidosis may be precipitated by the catabolic stress of acute illness such as trauma, surgery, or infections. Recent studies have suggested that sodium-glucose cotransporter-2 (SGLT-2) inhibitors precipitate DKA in Type 2 diabetes. We present a case series of four patients on SGLT-2 inhibitors who presented with DKA. Methods: Medical records were reviewed and patients who were admitted with diabetic ketoacidosis in the last one year at our institute were identified. The charts of such patients were reviewed and we were able to identify 4 patients who were admitted with DKA and were on SGLT-2 inhibitors at the time of admission for the management of their diabetes. Results: The age group of the four patients was between 45-65 years. Interestingly, all four patients were female. The admission blood glucose levels of these patients ranged from 203 to 400(mg/dl). The pH at the time of admission was in the acidotic range with anion gap ranging from 19 to 24. Two of these four patients had symptoms of a localized infection at the time of admission, which was confirmed by laboratory and radiological evaluation. Three of these patients required management in the intensive care unit. Conclusion: Ketoacidosis is a rare but serious side effect of SGLT2 inhibitors. It is being increasingly reported as these drugs are now commonly being prescribed in the primary care setting. Awareness that DKA can occur in the setting of relative euglycemia is critical to recognize this life-threatening complication of diabetes. More research is needed to better understand the underlying pathophysiology and precipitating factors leading to ketoacidosis in SGLT-2 inhibitor treated patients.

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