Predisposing factors for the development of diabetic ketoacidosis with lower than anticipated glucose levels in type 2 diabetes patients on SGLT2-inhibitors: a review

Adeboye Olakunle Bamgboye*, Isaac Oluwadamilare Oni, Andrew Collier

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

34 Citations (Scopus)

Abstract

Purpose: SGLT2-inhibitors (SGLT-2i) have been linked to the risk of potential life-threatening diabetic ketoacidosis (DKA). The U.S. Food and Drug Administration and the European Medicines Agency issued warnings in 2015 and 2016 respectively on the predisposing factors to the development of DKA in individuals on an SGLT2i. New predisposing factors to DKA are still being discovered with the use of SGLT-2i. The list by FDA and EMA is yet to be updated. This article aims to provide a holistic list that includes the newer factors that have been implicated in the development of DKA. The overall aim is to guide physicians in prescribing this class of drugs for type 2 diabetes mellitus (T2D). Method: A search was done using PUBMED, Google Scholar, and Directory of Open Access Journals with the following words: SGLT-2 Inhibitors AND Ketoacidosis were entered. We included articles from 2000 to 2020, those in English, those involving any of the approved SGLT2i medications in T2D patients, and studies that focused on DKA linked to SGLT-2i. These articles were reviewed, and relevant data extracted and compiled. Results and conclusion: The review has revealed that predisposing factors include (excess) alcohol consumption, female gender, starvation due to illness or fasting, withholding the use of SGLT2i for less than 48 h peri-operatively, and the existence of a variations in the expression of SGLT2 receptors. Patients should be advised on “sick day rules,” and if a patient becomes unwell while on an SGLT2i, they should be advised to withhold the medication for the duration of the intercurrent illness.

Original languageEnglish
Pages (from-to)651-657
Number of pages7
JournalEuropean Journal of Clinical Pharmacology
Volume77
Issue number5
Early online date26 Nov 2020
DOIs
Publication statusPublished - May 2021

Keywords

  • Euglycemic diabetic ketoacidosis
  • Predisposing
  • SGLT2-inhibitors
  • Type 2 diabetes

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

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