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.

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Title SGLT2 inhibitors increase the risk of diabetic ketoacidosis developing in the community and during hospital admission
Author(s) 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 AORCID iD for 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 name Journal of clinical endocrinology and metabolism
Volume number 104
Issue number 8
Start page 3077
End page 3087
Total pages 11
Publisher Oxford University Press
Place of publication Oxford, Eng.
Publication date 2019-08
ISSN 0021-972X
1945-7197
Keyword(s) Diabetic ketoacidosis (DKA)
Sodium glucose cotransporter 2 inhibitors (SGLT2is)
SGLT2 Inhibitors
Hospital Admission
Community
Summary Context
Diabetic ketoacidosis (DKA) has been associated with the use of sodium glucose cotransporter 2 inhibitors (SGLT2is).

Objective
To determine the incidence, characteristics, and outcomes of DKA in SGLT2i users vs nonusers with type 2 diabetes.

Design
Retrospective, multicenter, controlled cohort study.

Setting
All public hospitals in Melbourne and Geelong (combined population of 5 million), Australia, from 1 September 2015 to 31 October 2017.

Patients
Consecutive cases of DKA that developed in the community, or during the course of hospital admission, in patients with type 2 diabetes

Main Outcome Measures
In SGLT2i users vs nonusers: (i) OR of DKA developing during hospital admission, and (ii) incidence of DKA.

Results
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).

Conclusions
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.
Language eng
DOI 10.1210/jc.2019-00139
Indigenous content off
Field of Research 1103 Clinical Sciences
1114 Paediatrics and Reproductive Medicine
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2019, Endocrine Society
Persistent URL http://hdl.handle.net/10536/DRO/DU:30120709

Document type: Journal Article
Collections: Faculty of Health
School of Medicine
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