SGLT2 inhibitors increase the risk of diabetic ketoacidosis developing in the community and during hospital admission
Hamblin, Peter S, Wong, Rosemary, Ekinci, Elif I, Fourlanos, Spiros, Shah, Sonali, Jones, Alicia R, Hare, Matthew JL, Calder, Genevieve L, Epa, Dilan Seneviratne, George, Elizabeth M, Giri, Rinky, Kotowicz, Mark A, Kyi, Mervyn, Lafontaine, Nicole, MacIsaac, Richard J, Nolan, Brendan J, O'Neal, David N, Renouf, Debra, Varadarajan, Suresh, Wong, Jennifer, Xu, Sylvia and Bach, Leon A 2019, SGLT2 inhibitors increase the risk of diabetic ketoacidosis developing in the community and during hospital admission, Journal of clinical endocrinology and metabolism, vol. 104, no. 8, pp. 3077-3087, doi: 10.1210/jc.2019-00139.
Hamblin, Peter S
Wong, Rosemary
Ekinci, Elif I
Fourlanos, Spiros
Shah, Sonali
Jones, Alicia R
Hare, Matthew JL
Calder, Genevieve L
Epa, Dilan Seneviratne
George, Elizabeth M
Giri, Rinky
Kotowicz, Mark A orcid.org/0000-0002-8094-1411
Kyi, Mervyn
Lafontaine, Nicole
MacIsaac, Richard J
Nolan, Brendan J
O'Neal, David N
Renouf, Debra
Varadarajan, Suresh
Wong, Jennifer
Xu, Sylvia
Bach, Leon A
Journal of clinical endocrinology and metabolism
Oxford, Eng.
Diabetic ketoacidosis (DKA)
Sodium glucose cotransporter 2 inhibitors (SGLT2is)
Diabetic ketoacidosis (DKA) has been associated with the use of sodium glucose cotransporter 2 inhibitors (SGLT2is).
To determine the incidence, characteristics, and outcomes of DKA in SGLT2i users vs nonusers with type 2 diabetes.
Retrospective, multicenter, controlled cohort study.
All public hospitals in Melbourne and Geelong (combined population of 5 million), Australia, from 1 September 2015 to 31 October 2017.
Consecutive cases of DKA that developed in the community, or during the course of hospital admission, in patients with type 2 diabetes
In SGLT2i users vs nonusers: (i) OR of DKA developing during hospital admission, and (ii) incidence of DKA.
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 2 (2%) non-SGLT2i users (OR, 37.4; 95% CI, 8.0 to 175.9; P < 0.0001). The incidence of DKA was 1.02 per 1000 (95% CI, 0.74 to 1.41 per 1000) in SGLT2i users vs 0.69 per 1000 (95% CI, 0.58 to 0.82 per 1000) in non-SGLT2i users (OR, 1.48; 95% CI, 1.02 to 2.15; P = 0.037). Fifteen SGLT2i users (41%) had peak blood glucose <250 mg/dL (14 mmol/L) compared with one (0.8%) non-SGLT2i user (P < 0.001).
SGLT2i users were more likely to develop DKA as an inpatient compared with non-SGLT2i users. SGLT2i use was associated with a small but significant increased risk of DKA.
10.1210/jc.2019-00139
1103 Clinical Sciences
1114 Paediatrics and Reproductive Medicine
©2019, Endocrine Society
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