RT Journal Article
SR Electronic
T1 Euglycemic Diabetic Ketoacidosis: A Potential Complication of Treatment With Sodium–Glucose Cotransporter 2 Inhibition
JF Diabetes Care
JO Diabetes Care
FD American Diabetes Association
SP 1687
OP 1693
DO 10.2337/dc15-0843
VO 38
IS 9
A1 Peters, Anne L.
A1 Buschur, Elizabeth O.
A1 Buse, John B.
A1 Cohan, Pejman
A1 Diner, Jamie C.
A1 Hirsch, Irl B.
YR 2015
UL http://care.diabetesjournals.org/content/38/9/1687.abstract
AB OBJECTIVE Sodium–glucose cotransporter 2 (SGLT-2) inhibitors are the most recently approved antihyperglycemic medications. We sought to describe their association with euglycemic diabetic ketoacidosis (euDKA) in hopes that it will enhance recognition of this potentially life-threatening complication.RESEARCH DESIGN AND METHODS Cases identified incidentally are described.RESULTS We identified 13 episodes of SGLT-2 inhibitor–associated euDKA or ketosis in nine individuals, seven with type 1 diabetes and two with type 2 diabetes, from various practices across the U.S. The absence of significant hyperglycemia in these patients delayed recognition of the emergent nature of the problem by patients and providers.CONCLUSIONS SGLT-2 inhibitors seem to be associated with euglycemic DKA and ketosis, perhaps as a consequence of their noninsulin-dependent glucose clearance, hyperglucagonemia, and volume depletion. Patients with type 1 or type 2 diabetes who experience nausea, vomiting, or malaise or develop a metabolic acidosis in the setting of SGLT-2 inhibitor therapy should be promptly evaluated for the presence of urine and/or serum ketones. SGLT-2 inhibitors should only be used with great caution, extensive counseling, and close monitoring in the setting of type 1 diabetes.