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      Prolonged glucosuria and relapse of diabetic ketoacidosis related to SGLT2‐inhibitor therapy

      case-report

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          Abstract

          SGLT2 inhibitors (SGLT2i) are glucose‐lowering medications which increase the renal threshold for glucose reabsorption and promote glucosuria. Treatment with these agents raises serum ketone levels, and cases of diabetic ketoacidosis (DKA) during therapy have been reported. The duration of glucosuria and inpatient course of SGLT2i‐related DKA, however, is not well‐characterized. We report 11 inpatient cases of SGLT2i‐related DKA, including a subset of patients who experienced prolonged glucosuria and relapse of DKA during their hospitalization.

          Abstract

          SGLT2 inhibitors (SGLT2i) are known to increase serum ketones and predispose patients to diabetic ketoacidosis (DKA). The duration of glucosuria after stopping the medication is unknown, and the impact of SGLT2i use on the inpatient course of DKA is not well‐characterized. We identified 11 cases of SGLT2i‐related DKA, a subset of which suggest prolonged glucosuria after discontinuation of the medication.

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          AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY POSITION STATEMENT ON THE ASSOCIATION OF SGLT-2 INHIBITORS AND DIABETIC KETOACIDOSIS.

          Yehuda Handelsman, Robert Henry, Zachary Bloomgarden … (2016)
          AACE = American Association of Clinical Endocrinologists ACE = American College of Endocrinology DKA = diabetic ketoacidosis EMA = European Medicines Agency FDA = U.S. Food and Drug Administration SGLT-2 = sodium glucosecotransporter 2 T1D = type 1 diabetes T2D = type 2 diabetes.
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            Risk of Diabetic Ketoacidosis after Initiation of an SGLT2 Inhibitor

            Michael Fralick, Sebastian Schneeweiss, Elisabetta Patorno (2017)
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              International Consensus on Risk Management of Diabetic Ketoacidosis in Patients With Type 1 Diabetes Treated With Sodium–Glucose Cotransporter (SGLT) Inhibitors

              Thomas Danne, Satish Garg, Anne Peters … (2019)
              Sodium–glucose cotransporter (SGLT) inhibitors are new oral antidiabetes medications shown to effectively reduce glycated hemoglobin (A1C) and glycemic variability, blood pressure, and body weight without intrinsic properties to cause hypoglycemia in people with type 1 diabetes. However, recent studies, particularly in individuals with type 1 diabetes, have demonstrated increases in the absolute risk of diabetic ketoacidosis (DKA). Some cases presented with near-normal blood glucose levels or mild hyperglycemia, complicating the recognition/diagnosis of DKA and potentially delaying treatment. Several SGLT inhibitors are currently under review by the U.S. Food and Drug Administration and European regulatory agencies as adjuncts to insulin therapy in people with type 1 diabetes. Strategies must be developed and disseminated to the medical community to mitigate the associated DKA risk. This Consensus Report reviews current data regarding SGLT inhibitor use and provides recommendations to enhance the safety of SGLT inhibitors in people with type 1 diabetes.
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                Author and article information

                Contributors
                Florence M. Brown: florence.brown@joslin.harvard.edu
                Journal
                Journal ID (nlm-ta): Endocrinol Diabetes Metab
                Journal ID (iso-abbrev): Endocrinol Diabetes Metab
                Journal ID (doi): 10.1002/(ISSN)2398-9238
                Journal ID (publisher-id): EDM2
                Title: Endocrinology, Diabetes & Metabolism
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Electronic): 2398-9238
                Publication date (Electronic): 29 February 2020
                Publication date Collection: April 2020
                Volume: 3
                Issue: 2 ( doiID: 10.1002/edm2.v3.2 )
                Electronic Location Identifier: e00117
                Affiliations
                [ 1 ] Joslin Diabetes Center Boston Massachusetts
                [ 2 ] Beth Israel Deaconess Medical Center Boston Massachusetts
                [ 3 ] MCPHS University Boston Massachusetts
                Author notes
                [*] [* ] Correspondence

                Florence M. Brown, Joslin Diabetes Center, 1 Joslin Place, Boston, MA 02215.

                Email: florence.brown@ 123456joslin.harvard.edu

                Author information
                https://orcid.org/0000-0002-4321-3992
                Article
                Publisher ID: EDM2117
                DOI: 10.1002/edm2.117
                PMC ID: 7170458
                PubMed ID: 32318635
                SO-VID: 4232826a-66ae-4371-bd36-fd4e87a218db
                Copyright © © 2020 The Authors. Endocrinology, Diabetes & Metabolism published by John Wiley & Sons Ltd.
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 24 January 2020
                Date accepted : 02 February 2020
                Page count
                Figures: 1, Tables: 1, Pages: 4, Words: 2797
                Categories
                Subject: Case Report
                Subject: Case Reports
                Custom metadata
                source-schema-version-number 2.0
                cover-date April 2020
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.1 mode:remove_FC converted:20.04.2020

                Keywords: diabetic ketoacidosis,inpatient diabetes management,prolonged glucosuria,sglt2 inhibitors
                Data availability:
                Keywords: diabetic ketoacidosis, inpatient diabetes management, prolonged glucosuria, sglt2 inhibitors

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