Endocrine Abstracts

Aims: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) increase the risk for diabetic ketoacidosis, particularly in patients with type 1 diabetes (T1DM). We aimed to determine whether SGLT2i use increase the risk of euglycemic diabetic ketoacidosis (euDKA) and to indicate its demographic, clinical features.

Methods: We performed a retrospective cohort study of 51 patients over 18 years-old admitted to emergency unit at a tertiary care hospital from 2018-2022. The data were collected by communicating with the hospital network system, national health registry, and personnel communication. Fisher’s exact, Yates’s chi-square, and Mann-Whitney-U tests were used to identify variables associated with euDKA initiation using SPSS-version23.

Results: We included 51 DKAs, of whom 33 (64.7%) were female out of 508 patients with hyperglycemia in the emergency department. T1DM, type 2 DM and latent autoimmune diabetes in adults (LADA) were present in 25 (49%), 22 (43.2%), and 4 (7.8%), respectively. 156 (30.7%) patients used SGLT2 and 19 (37.3%) of these patients were diagnosed with DKA. Regarding SGLT2i use there was no significant correlation between DKA and patients with non-DKA hyperglycemia (P=0.364). 15 and 4 patients with DKA had T2DM and LADA. SGLT2i use was significantly higher in patients with type 2 DM (P<0.05). All patients with LADA were using the SGLT2i which prescribed at different centres. The median age of patients using SGLT2i was 59.16 ± 17.63, BMI 25.09±4.80, plasma glucose 397.89±191.07, HbA1C 11.24±2.51, pH 7.17±0.16, HCO3 12.02±5.56. The mean age of patients using SGLT2i was significantly higher, plasma glucose levels were lower (P<0.05). There is a significant correlation between euDKA (n=5, 9.8%) and SGLT2i use (P=0.005). All 5 patients were using SGLT2i. There were 13 (25.4%) patients with urinary tract infection (UTI) of which 9 (69.2%) were female. The number of patients with any genitourinary infection (GUI) in women was 15 (45.5%). There was also a significant correlation between the use of SGLT2i and urinary tract infection (UTI), vulvavaginitis (n=6, 18.2%), GUI in women and in general (n=19, 37.3%) (P=0.050, P=0.002, P=0.013, P=0.008), respectively. In the euDKA group, 3 out of 5 patients required intensive care and one patient was dead.

Conclusions: We observed euDKA, DKA in T2DM and GUI (UTI or vulvavaginitis) cases were more common in patients using SGLT2i. Furthermore, we suggest that LADA should be excluded before starting SGLT2i. In sum, SGLT2i may increase the risk of the serious adverse events that should not overshadow the significant cardioprotective benefits and therefore carefully prescribed.