Possible risk factors for the development of sodium-glucose co-transporter 2 inhibitor- associated diabetic ketoacidosis in type 2 diabetes
Keywords:SGLT-2 inhibitors, diabetic ketoacidosis
AbstractBackground: In the summer of 2015 the Food and Drug Administration and European Medicines Agency reported that over 100 cases of diabetic ketoacidosis (DKA) had been identified and issued a warning of increasing concerns of a possible link between sodium-glucose co-transporter 2 (SGLT-2) inhibitor use and the development of DKA. Several mechanisms for this have been postulated, but precisely what factors predispose individuals to develop DKA remain unknown.
Methods: We conducted a literature search on Pubmed and Ovid databases and Google Scholar and report a further case of DKA occurring in a patient with a 16-year history of type 2 diabetes 10 months after starting dapagliflozin.
Results: Very few cases of DKA occurring in type 2 diabetes have been reported. Most cases of DKA have occurred in patients with type 1 diabetes taking part in clinical trials or given the drug ‘off licence’. Several potential mechanisms for developing DKA have been postulated. In addition to these, we suggest that a prolonged history of type 2 diabetes may lead to reduced beta cell reserve, increasing the probability of developing DKA.
Conclusion: Despite the insulin-independent mode of action, SGLT-2 inhibitors are currently only licensed for use in type 2 diabetes. If the duration of diabetes is long and/or if insulin doses are reduced on initiation, clinicians and patients should be wary of signs of DKA. Until further data are available, unlicensed use in type 1 diabetes should be avoided.
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