• Peter S Hamblin, Rosemary Wong, Elif I Ekinci, Spiros Fourlanos, Sonali Shah, Alicia R Jones, Matthew J L Hare, Genevieve L Calder, Epa Dilan Seneviratne DS Department of Diabetes and Endocrinology, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia., Elizabeth M George, Rinky Giri, Mark A Kotowicz, Mervyn Kyi, Nicole Lafontaine, Richard J MacIsaac, Brendan J Nolan, David N O'Neal, Debra Renouf, Suresh Varadarajan, Jennifer Wong, Sylvia Xu, and Leon A Bach.
• Department of Endocrinology and Diabetes, Western Health, St. Albans, Victoria, Australia.
• J. Clin. Endocrinol. Metab. 2019 Aug 1; 104 (8): 3077-3087.

ContextDiabetic ketoacidosis (DKA) has been associated with the use of sodium glucose cotransporter 2 inhibitors (SGLT2is).ObjectiveTo determine the incidence, characteristics, and outcomes of DKA in SGLT2i users vs nonusers with type 2 diabetes.DesignRetrospective, multicenter, controlled cohort study.SettingAll public hospitals in Melbourne and Geelong (combined population of 5 million), Australia, from 1 September 2015 to 31 October 2017.PatientsConsecutive cases of DKA that developed in the community, or during the course of hospital admission, in patients with type 2 diabetes.Main Outcome MeasuresIn SGLT2i users vs nonusers: (i) OR of DKA developing during hospital admission, and (ii) incidence of DKA.ResultsThere 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).ConclusionsSGLT2i 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.

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