60th EASD Annual Meeting of the European Association for the Study of Diabetes
Year: 2024
Type: article
Study design: Observational Study
Abstract: : Background and aims: Sodium Glucose CoTransporter 2 Inhibitors (SGLT2i) not only reduce glucose levels, they significantly improve cardiac and renal risk. With prescriptions increasing, the risk for the uncommon but severe complication: SGLT2i associated diabetic ketoacidosis (SGLT2i-DKA) is increasing. Knowledge of how this occurs in hospitalised patients is still evolving. Materials and methods: From 2021 to 2023, incidences of SGLT2i-DKA referred to the diabetes service of a quaternary referral hospital in Australia’s largest city were collated and assessed against pharmacy data of all SGLT2is dispensed over 12 matching months [NB data was missed over 3 contiguous months in 2022]. For the two cohorts clinical and admission data were compared while the characteristics of each SGLT2i-DKA event were analysed in detail. Results: Five% (n=35) of inpatients on SGLT2i (n=735) experienced SGLT2i-DKA; of the DKA cohort 89% came via ED, 9% elective & 3% facility transfers; 40% were surgical team admissions (p=0.01) & 37% had surgery (p<0.001). Finally 9% experienced sepsis (p=0.01). DKA di"ered from all SGLT2i users for % T2DM (100 vs 80%; p=0.01), HbA1c (9.4% vs 8.4% p=0.01), SGLT2i choice (Empa & Dapa 94% & 6% vs. 50% & 50% p<0.01) and % on insulin (37% vs 24%, p=0.04). Cohorts did not di"er by age, gender or length of stay (DKA vs no DKA; mean or %: 64.5 vs 67.5 years; %M 54 vs 69; 11.5 vs 13.0 days) nor other baseline diabetes therapies. After fasting DKA developed by (mean) 12±6.3hrs; the initial pH 7.3 (range 7-7.4) & BGL (mean 17±12 mmol/L) demonstrated acidosis and hyperglycaemia. After treatment with fluids and insulin (11% progressed to severe DKA/HHS; 20% were transferred to ICU/HDU) the event resolved by 4hrs and to date all SGLT2—DKA events survived their admission through to discharge. The Table displays more characteristics of SGLT2i-DKA cohort. Conclusion: Over 12 months, SGLT2i-DKA occurred in 5% of admissions prescribed SGLT2is. While not uncommon, this rate is an underestimate of the true value. Compared to all SGLT2i use, SGLT2i DKA cohort had worse control of DM and more sepsis and surgery, and were under surgical teams. When the event occurred, it typically was promptly treated and not been associated with fatalities. While the reference hospital is a quaternary level institution in Australia’s largest city smaller centres do not have the same specialist services, sta#ng or level of care. Therefore, knowledge around SGLT2i-DKA characteristics allows diabetes services and health networks to develop strategies that can reduce incidence and improve detection of the event, and refine treatment protocols for this potentially serious in hospital complication.
Source: Diabetologia
Authors: Hangaard, S.; id_orcid 0000-0003-0395-3563, Kronborg, T.; id_orcid 0000-0002-2693-0527, Cohen, S., Kofoed-Enevoldsen, A., Rasmussen, M., Pedersen, L., Thomsen, C.; id_orcid 0000-0001-6229-7282, Aradottir, T., Kristensen, S., Kaas, A., Bengtsson, H., Dethlefsen, C., Hejlesen, O., Vestergaard, P.; id_orcid 0000-0002-9046-2967, Jensen, M.
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funder: Agence Nationale de la Recherche
OpenAlex ID: W4402495415