Table 1

Thirteen cases of SGLT2 inhibitor–associated DKA within South Australia from December 2015 to March 2017

Age (years) and sex67 F67 F38 F82 M55 F53 M64 F70 M52 M45 F59 F75 F67 F
T1 antibody titers, IU/mL (normal <10.0)
Duration of diabetes>20 years11 years6 months14 years12 yearsUNK35 years10 years15 years27 years47 yearsUNKUNK
InsulinGlargine 8 units d.; NovoRapid 3 units t.d.s.Humalog Mix25 45 units breakfast, 12 units evening mealNoneNoneNovoMix30 30 units breakfast, 12 units evening mealNoneGlargine 14 units mane, 5 units evening; NovoRapid 1–5 units t.d.s.Glargine 56 units d.Glargine 20 units d.Glargine 70 units mane, 50 units eveningNoneUNKGlargine 14 units d.; NovoRapid 3 units t.d.s.
SGLT2 inhibitorDapagliflozin 10 mgDapagliflozin 10 mgDapagliflozin 10 mgDapagliflozin 10 mgEmpagliflozin UNKDapagliflozin 10 mgDapagliflozin 10 mgDapagliflozin 10 mgEmpagliflozin 5 mgDapagliflozin 10 mgEmpagliflozin UNKDapagliflozin 10 mgEmpagliflozin 25 mg
Duration of SGLT2 inhibitor6 months6 months5 months3 months1 month2 weeks2 weeks2 months6 months6 monthsUNKUNK3 weeks
OAHMetforminMetforminMetformin, linagliptinGliclazide MR, metforminMetforminMetformin XR, sitagliptinMetforminMetforminMetforminMetformin, acarboseMetformin, sitagliptinMetforminMetformin, gliclazide
HbA1c, % (mmol/mol)8.3 (67)6.5 (48)10.1 (87)9.3 (78)10.9 (96)9.6 (81)9.7 (83)13.4 (123)9.8 (84)10.2 (88)7.6 (60) (anemic)UNK6.8 (51)
Potential contributorsReduced oral intake, missed insulin, missed T1DDiarrhea, AKI, UTIMissed T1DCABGGastroenteritis, missed insulinNo precipitantMissed insulinInfluenza A, staphylococcal pneumonia and bacteremiaNecrotizing fasciitisCeased insulin 2 weeks priorChemotherapy for breast cancer, blood dyscrasia, candiduriaTakotsubo cardiomyopathy, LV thrombus, cardiogenic shock, cardiopulmonary arrestMissed insulin 3 days, acute cholecystitis
Insulin reductionYes, glargine by 2 unitsInsulin ceased 6 weeks priorUNKUNKYesUNKYes, glargine by 4 unitsNoNoCeased insulinUNKUNKMissed insulin
BGL, mmol/L (normal 3.2–5.5)8.69.7136.82013.81129UNK1534.629.718.7
pH (normal 7.38–7.45)7.0UNKUNK7.3UNK7.37.17.2UNK7.16.96.9UNK
Ketones, β-hydroxybutyrate, mmol/L (normal <0.30)3.0 (12 h)71373.5 (24 h)5.86.06UNK6.25.27UNK
Bicarbonate, mmol/L (normal 22–32)613.821441451157.7376
Anion gap, mmol/L (normal 7–17)24243226413232343826484240
Admission dateDecember 2015December 2015January 2016June 2016June 2016July 2016August 2016September 2016September 2016October 2016October 2016March 2017March 2017
Insulin infusion duration48 hUNK48 h24 h24 h48 h48 h24 h48 h48 hUNKUNKUNK
  • Note blood glucose level (BGL) and laboratory results are taken from time of hospital admission. AKI, acute kidney injury; CABG, coronary artery bypass grafting; d., once daily; HDU, high dependency unit; ICU, intensive care unit; LV, left ventricular; OAH, oral antihyperglycemic agent; t.d.s., three times a day; UNK, unknown; UTI, urinary tract infection.

  • * Diagnosis of T1D made after reevaluation post–DKA presentation.