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.