S. Lejlic, G. Holmaas, K. Løvås and GÅ. Ueland (2023). Diabetic ketoacidosis with SGLT2 inhibitor use - a patient series. Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke, 143(3). https://doi.org/10.4045/tidsskr.22.0485

PubMed 36811444

[Abstract]
BACKGROUND: Inhibitors of sodium glucose cotransporter 2 (SGLT2 inhibitors) are increasingly being used to treat type 2 diabetes. Results from previous studies suggest a rising incidence of diabetic ketoacidosis with the use of this medication.

MATERIAL AND METHOD: We performed a diagnosis search in the electronic patient records at Haukeland University Hospital for the period 1 January 2013-31 May 2021 with the aim of identifying patients with diabetic ketoacidosis who used SGLT2 inhibitors. A total of 806 patient records were reviewed.

RESULTS: Twenty-one patients were identified. Thirteen had severe ketoacidosis, and ten had normal blood glucose levels. Probable triggering causes were found in 10 of the 21, with recent surgery being the most common (n = 6). Three of the patients were not tested for ketones, and 9 were not tested for antibodies to rule out type 1 diabetes.

INTERPRETATION: The study showed that severe ketoacidosis occurs in patients with type 2 diabetes using SGLT2 inhibitors. It is important to be aware of this risk and the fact that ketoacidosis can occur without hyperglycaemia. Arterial blood gas and ketone tests must be performed to make the diagnosis.