• Intern Emerg Med · Nov 2024

    Chronic treatment with SGLT-2 inhibitors is associated with ICU admission and disease severity in patients with diabetic ketoacidosis: a propensity score-matched cohort study.

    • Fernando Sebastian-Valles, Maria Sara Tapia-Sanchiz, Victor Navas-Moreno, Marta Lopez-Ruano, Carmen Martínez-Otero, Elena Carrillo-López, Carolina Sager La Ganga, Juan José Raposo-López, Selma Amar, Sara González-Castañar, Andres Von Wernitz Teleki, Carmen Del Arco, Jose Alfonso Arranz-Martín, and Mónica Marazuela.
    • Department of Endocrinology and Nutrition, Universidad Autónoma de Madrid, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Diego de León 62, 28005, Madrid, Spain. fernando.sebastian@estudiante.uam.es.
    • Intern Emerg Med. 2024 Nov 18.

    AbstractSGLT-2 inhibitors (SGLT-2i) are linked to a higher risk of diabetic ketoacidosis (DKA). However, it is still unclear whether the severity of SGLT-2i associated DKA is higher. This is a retrospective cohort study with patients admitted for DKA at a tertiary hospital (2013-2024). Patients were matched by propensity score for age, sex, diabetes duration, type, and ischemic heart disease. ICU admission risk and clinical severity were compared between SGLT-2i users and controls. The matched sample included 105 subjects (35 SGLT-2i users, 70 controls). The average age was 63.1 ± 15.4 years, and 40 (38.1%) patients were women. ICU admission was higher in the treatment group (65.7% versus 24.6%, p < 0.001). A conditional logistic regression showed higher risk of ICU admission in the treatment group (odds ratio 12.7, 95% confidence interval 1.9-84.3, p = 0.009) after adjusting for confounding factors. The treatment group exhibited less favorable blood gas results (pH 7.10 ± 0.17 vs 7.18 ± 0.16, p = 0.024) and shorter symptom duration (2 [1-3] vs 3 [2-7] days, p < 0.002). No significant differences were found in diabetes type, ketonemia, creatinine, or DKA precipitating factors. DKA in patients with diabetes treated with SGLT-2i is associated with more severe acidosis with quicker onset, leading to higher risk of ICU admission compared to patients not receiving this treatment. We recommend temporary discontinuation of SGLT-2i during any acute event until resolution, regardless of diabetes type or the patient's glycemic control.© 2024. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).

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