Purpose

Diabetic ketoacidosis (DKA) is a rare and life-threatening complication in patients with diabetes. Sodium–glucose co-transporter-2 inhibitors (SGLT2i) have rarely been associated with ketoacidosis. The aim of this retrospective study was to investigate DKA episodes occurring after SGLT2i treatment and to compare them to DKA episodes due to other causes.

Methods

The medical records of the years 2018–2020 related to clinical and biochemical characteristics and to treatment of six patients with DKA due to SGLT2i were reviewed. They were compared to those of 12 patients with DKA due to other causes.

Results

On admission, the most common symptom was abdominal pain. Glucose levels (median, min–max) were lower in patients with SGLT2i-induced DKA compared to those with DKA due to other causes (229 (150–481) vs. 458.5 (332–695) mg/dl, p = 0.007), whereas no statistical difference was observed in HbA1c and in the severity of DKA (pH, HCO₃, CO₂, and anion gap). The duration of insulin infusion (41 (33–124) vs. 21.50 (11–32) h, p < 0.001) and the time required until DKA resolution (39 (31–120) vs. 19 (9–28) h, p < 0.001) were higher in patients with SGLT2i-induced DKA than those with DKA due to other causes. In addition, there were increased fluid requirements (14 (8–22.75) vs. 5.5 (2–24) L, p = 0.013) and longer hospitalization time (11 (6–22) vs. 5.5 (2–14) days, p = 0.024) in patients with SGLT2i-induced DKA. No statistically significant differences were observed in total intravenous insulin and potassium administration until DKA resolution.

Conclusions

Patients with SGLT2i-induced DKA had lower serum glucose levels on admission and required increased fluid administration and longer time to recover from acidosis compared to patients with DKA from other causes.

中文翻译：

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接受 SGLT2 抑制剂治疗的糖尿病酮症酸中毒：在三级医院的经验

目的

糖尿病酮症酸中毒 (DKA) 是糖尿病患者罕见且危及生命的并发症。钠-葡萄糖协同转运蛋白 2 抑制剂 (SGLT2i) 很少与酮症酸中毒有关。这项回顾性研究的目的是调查 SGLT2i 治疗后发生的 DKA 发作，并将其与其他原因引起的 DKA 发作进行比较。

方法

回顾了 2018-2020 年与临床和生化特征以及 6 名 SGLT2i 所致 DKA 患者治疗相关的医疗记录。他们与 12 名因其他原因患有 DKA 的患者进行了比较。

结果

入院时，最常见的症状是腹痛。与其他原因引起的 DKA 患者相比，SGLT2i 诱导的 DKA 患者的葡萄糖水平（中值，最小值-最大值）较低（229 (150-481) 与 458.5 (332-695) mg/dl，p  = 0.007） ，而在 HbA1c 和 DKA 的严重程度（pH、HCO ₃、CO ₂和阴离子间隙）方面没有观察到统计学差异。胰岛素输注的持续时间（41 (33-124) 与 21.50 (11-32) 小时，p  < 0.001）和直至 DKA 消退所需的时间（39 (31-120) 与 19 (9-28) 小时，p  < 0.001) 在 SGLT2i 诱导的 DKA 患者中高于因其他原因导致 DKA 的患者。此外，液体需求增加（14 (8–22.75) 比 5.5 (2–24) L，p = 0.013) 和 SGLT2i 诱导的 DKA 患者住院时间更长（11 (6-22) 天对 5.5 (2-14) 天，p = 0.024）。在 DKA 消退之前，总静脉注射胰岛素和钾的给药没有观察到统计学上的显着差异。

结论

与其他原因引起的 DKA 患者相比，SGLT2i 诱导的 DKA 患者入院时的血清葡萄糖水平较低，需要增加补液量和更长的时间才能从酸中毒中恢复。