Sodium‐glucose cotransporter 2 inhibitor‐associated diabetic ketoacidosis: Report of two cases with hyperglycemic ketoacidosis in type 1 diabetes

Sodium–glucose cotransporter 2 inhibitor‐associated diabetic ketoacidosis in patients with type 1 diabetes: Metabolic imbalance as an underlying mechanism

“…Do we need to be concerned about DKA if the dose of insulin is not reduced? The insulin dose was not decreased, but was instead increased, in a previously reported case of DKA in a patient with type 1 diabetes (Table , case 10). It is not clear whether DKA in this case was triggered by the SGLT2 inhibitor and the associated “metabolic imbalance” or by factors unrelated to the drug.…”

“…Possible contributing factors to the development of DKA included acute illness (pneumonia, influenza, sepsis, gastroenteritis, nonspecified viral infection and tooth extraction with a root canal), insulin pump malfunction, intake of a low‐carbohydrate diet, increased alcohol consumption and non‐compliance with insulin therapy. Furthermore, cases of SGLT2 inhibitor‐related DKA in patients with type 1 diabetes in clinical practice, in which the drugs were used off‐label, have been reported (Table ). The insulin dose was reduced in seven of eight cases for which such dose information was available.…”

Lesson of the Week: In the Nick of Time!

“…Soon after the introduction of this class, the risk of diabetic ketoacidosis (DKA) after initiation of SGLT2 inhibitors has been suggested by several case reports, including cases of T1DM. 11 12 13 14 Also, analysis of an extensive database of commercially insured patients 15 suggested that SGLT2 inhibitors were associated with twice the risk of DKA as were DPP4 inhibitors. However, cases of DKA leading to hospitalization were infrequent.…”

Sodium‐glucose co‐transporter inhibitors as adjunctive treatment to insulin in type 1 diabetes: A review of randomized controlled trials

“…As summarized thus far, although the incidence of DKA was low overall, SGLT‐2 inhibitors and SGLT‐1/2 inhibitors were associated with an increased risk of DKA when added to insulin in patients with T1D (Table ). Furthermore, reports of DKA among patients with T1D treated with SGLT‐2 inhibitors have been noted in case studies . The prescribing information for each SGLT‐2 inhibitor approved for T2D also contains a warning regarding the risk of DKA .…”