Endocrine Abstracts

SGLT2i drugs have been funded by the Israeli health basket since 2017 for patients with type-2-diabetes and previous cardiovascular disease, as a result of the EMPA-REG outcome studies documenting 34% reduction in all-cause mortality. In 2015 the FDA warned that SGLT2i may result in diabetic-ketoacidosis (DKA). The reported DKA cases were not typical because many had type-2-diabetes and their blood glucose was slightly increased.

Objective: To describe DKA cases among patients treated with SGLT2i hospitalized in the Hadera region.

Methods: The electronic files of all hospitalized patients with DKA diagnosis (codes 250.10-13) during 2015-2017 were reviewed. Patients on SGLT2i treatment were analyzed.

Results: No cases were documented in 2015, two in 2016 and nine in 2017. DKA diagnosis and treatment within the hospital was delayed in 2(18%), length of hospital stay was 5.3±1.9 days, 10 (91%) were diagnosed in the community as type-2-diabetes. Antidiabetic treatment: insulin 7(64%), metformin 7(64%), DPP-IVi 5(45%), GLP-1 agonist 3(27%) and sulfonylureas 2(18%). Mean blood glucose was 280±84. Precipitating factors: 2(18%) had infection, 1(9%) drinking alcohol, 6(86%) stopped insulin. Four (40%) had pre-hospitalization clinical signs suggestive of LADA, of these: 3 were insulin treated, and 2 had recurrent DKA. Severity score was: 2(18%)-mild, 4(36%)-moderate and 5(45%)-severe; one died. Two restarted SGLT2i treatment after hospitalization, one recurred with DKA.

Conclusion: Patients with obvious insulin deficiency are being treated with SGLT2i, including some with previous DKA. Community and the medical center physicians and nurses should be aware of the a-typical presentation of DKA among patients with diabetes and SGLT2i.