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Title: | SGLT2 Inhibitors Increase the Risk of Diabetic Ketoacidosis Developing in the Community and during Hospital Admission. | Authors: | Lafontaine N.;Wong R.;Ekinci E.I.;Fourlanos S.;Shah S. ;Jones A.R.;Hare M.J.L.;Calder G.L.;Epa D.S.;George E.M.;Giri R.;Kotowicz M.A.;Kyi M.;Macisaac R.J.;Nolan B.J.;O'Neal D.N.;Renouf D.;Varadarajan S.;Wong J.;Xu S.;Bach L.A.;Hamblin P.S. | Institution: | (Hamblin, Jones) Department of Endocrinology and Diabetes, Western Health, 176 Furlong Road, St. Albans, VIC 3021, Australia (Hamblin) Department of Medicine, Western Precinct, University of Melbourne, St Albans, VIC 3021, Australia (Wong, Lafontaine) Department of Endocrinology and Diabetes, Eastern Health, Box Hill, VIC 3128, Australia (Ekinci, Nolan) Department of Endocrinology, Austin Health, Heidelberg, VIC 3084, Australia (Ekinci) Department of Medicine, Austin Health, University of Melbourne, Heidelberg 3084, Australia (Fourlanos, Kyi) Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, VIC 3050, Australia (Fourlanos, Kyi) Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC 3050, Australia (Shah, Wong) Department of Endocrinology and Diabetes, Monash Health, Clayton, VIC 3168, Australia (Hare, Bach) Department of Endocrinology and Diabetes, Alfred Health, Melbourne, VIC 3004, Australia (Calder, Epa, Macisaac) Department of Diabetes and Endocrinology, St. Vincent's Hospital Melbourne, Fitzroy, VIC 3065, Australia (George, Kotowicz) Department of Endocrinology and Diabetes, University Hospital Geelong, Barwon Health, Geelong, VIC 3220, Australia (Giri, O'Neal) Werribee Mercy Hospital, Werribee, VIC 3030, Australia (Giri) Diabetes Technology Research Group, St. Vincent's Hospital Melbourne, Fitzroy, VIC 3065, Australia (Kotowicz) School of Medicine, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia (Macisaac, O'Neal) Department of Medicine, St. Vincent's Hospital Melbourne, University of Melbourne, Fitzroy, VIC 3065, Australia (Nolan, Varadarajan) Department of Endocrinology and Diabetes, Northern Health, Epping, VIC 3076, Australia (Renouf, Xu) Department of Endocrinology and Diabetes, Peninsula Health, Frankston, VIC 3199, Australia (Renouf) Peninsula Clinical School, Monash University, Frankston, VIC 3199, Australia (Bach) Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia | Issue Date: | 16-Jul-2019 | Copyright year: | 2019 | Publisher: | Endocrine Society (E-mail: mzendell@endo-society.org) | Place of publication: | United States | Publication information: | Journal of Clinical Endocrinology and Metabolism. 104 (8) (pp 3077-3087), 2019. Date of Publication: 19 Jun 2019. | Journal: | Journal of Clinical Endocrinology and Metabolism | Abstract: | Context Diabetic ketoacidosis (DKA) has been associated with the use of sodium glucose cotransporter 2 inhibitors (SGLT2is). Objective To determine the incidence, characteristics, and outcomes of DKA in SGLT2i users vs nonusers with type 2 diabetes. Design Retrospective, multicenter, controlled cohort study. Setting All public hospitals in Melbourne and Geelong (combined population of 5 million), Australia, from 1 September 2015 to 31 October 2017. Patients Consecutive cases of DKA that developed in the community, or during the course of hospital admission, in patients with type 2 diabetes Main Outcome Measures In SGLT2i users vs nonusers: (i) OR of DKA developing during hospital admission, and (ii) incidence of DKA. Results There were 162 cases of DKA (37 SGLT2i users and 125 non-SGLT2i users) with a physician-adjudicated diagnosis of type 2 diabetes. Of these, DKA developed during the course of inpatient admission in 14 (38%) SGLT2i users vs 2 (2%) non-SGLT2i users (OR, 37.4; 95% CI, 8.0 to 175.9; P < 0.0001). The incidence of DKA was 1.02 per 1000 (95% CI, 0.74 to 1.41 per 1000) in SGLT2i users vs 0.69 per 1000 (95% CI, 0.58 to 0.82 per 1000) in non-SGLT2i users (OR, 1.48; 95% CI, 1.02 to 2.15; P = 0.037). Fifteen SGLT2i users (41%) had peak blood glucose <250 mg/dL (14 mmol/L) compared with one (0.8%) non-SGLT2i user (P < 0.001). Conclusions SGLT2i users were more likely to develop DKA as an inpatient compared with non-SGLT2i users. SGLT2i use was associated with a small but significant increased risk of DKA.Copyright © 2019 Endocrine Society. | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1210/jc.2019-00139 | PubMed URL: | 30835263 [http://www.ncbi.nlm.nih.gov/pubmed/?term=30835263] | ISSN: | 0021-972X | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/36050 | Type: | Article | Subjects: | article adult aged cohort analysis controlled study *diabetic ketoacidosis disease course female glucose blood level *hospital admission hospital patient human incidence major clinical study male multicenter study non insulin dependent diabetes mellitus/dt [Drug Therapy] outcome assessment priority journal public hospital retrospective study *risk factor treatment outcome glucose/ec [Endogenous Compound] *sodium glucose cotransporter 2 inhibitor/dt [Drug Therapy] human incidence major clinical study male multicenter study non insulin dependent diabetes mellitus / drug therapy outcome assessment priority journal aged retrospective study *risk factor treatment outcome adult public hospital Article cohort analysis controlled study *diabetic ketoacidosis disease course female glucose blood level *hospital admission hospital patient |
Type of Clinical Study or Trial: | Observational study (cohort, case-control, cross sectional or survey) |
Appears in Collections: | Articles |
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