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

2020 ◽  
Author(s):  
Adeboye Olakunle Bamgboye ◽  
Isaac Oluwadamilare Oni ◽  
Andrew Collier
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Sglt2 Inhibitors ◽  
Predisposing Factors ◽  
Glucose Levels ◽  
Diabetes Patients

scholarly journals Effect of glucose on reduced glutathione level in Malay uncomplicated type 2 diabetes patients

2021 ◽  
pp. 13
Author(s):  
Subandrate ◽  
Raafqi Ranasasmita
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Free Radical ◽  
Reduced Glutathione ◽  
Normal Subjects ◽  
Random Blood Glucose ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Diabetes Patients

Background: Increasing blood sugar level may increase free radical compounds in type 2 diabetes. Free radical compounds can cause oxidative stress, thereby decreasing endogenous antioxidants such as reduced glutathione (GSH). Objective: This study aimed to determine whether random blood glucose levels affect GSH in type 2 diabetes patients within the Malay race. Methods: This study was observational with case-control, involving 25 patients with uncomplicated type 2 diabetes (receiving metformin and/or glimipiride) and 25 healthy controls. Random blood glucose levels were determined using ACCU-CHECK® Kit. Blood GSH levels were determined by Sigma GSH Assay Kit. Results: Results show that type 2 diabetes patients have a significantly lower random blood glucose level compared with those of age-matched normal subjects (p<0.0001). Type 2 diabetic patients had significantly lower levels of GSH (p=0.00) than those of age-matched normal subjects. We found a moderate negative correlation (r=-0.437 and p=0.02) between the level of random blood glucose and the level of GSH. Conclusion: The depletion of GSH during hyperglycemia may neutralize the free radicals indirectly generated by the abundant of glucose.  

scholarly journals Comparative risk evaluation for cardiovascular events associated with dapagliflozin vs. empagliflozin in real-world type 2 diabetes patients: a multi-institutional cohort study

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Shih-Chieh Shao ◽  
Kai-Cheng Chang ◽  
Ming-Jui Hung ◽  
Ning-I Yang ◽  
Yuk-Ying Chan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Type 2 Diabetes ◽  
Cohort Study ◽  
Ischemic Stroke ◽  
Cardiovascular Events ◽  
Cardiovascular Death ◽  
Sglt2 Inhibitors ◽  
Diabetes Patients

Abstract Background To compare the cardiovascular event risk in type 2 diabetes patients newly receiving dapagliflozin vs. empagliflozin. Methods We conducted a retrospective cohort study by analyzing a multi-institutional electronic medical records database (Chang Gung Research Database) in Taiwan and included adult type 2 diabetes patients who were newly receiving sodium–glucose co-transporter 2 (SGLT2) inhibitors from 2016 to 2017. The primary outcome was a composite of cardiovascular death, myocardial infarction, ischemic stroke and heart failure. We followed up patients from initiation of SGLT2 inhibitors until the occurrence of cardiovascular events before December 31, 2018. We performed multivariable Cox proportional hazard modeling, adjusting for patients’ age, sex, laboratory data, co-morbidities, and concomitant medications. Results We identified 12,681 new SGLT2 inhibitor users with a mean age of 58.9 (SD 11.8) years, of whom 43.9% were female and 45.8% were new dapagliflozin users. A total of 10,442 person-years of dapagliflozin use and 12,096 person-years of empagliflozin use were included. Compared to empagliflozin users, new users of dapagliflozin were found to have similar risks for primary composite outcome (adjusted HR: 0.91; 95% CI 0.73–1.14), cardiovascular death (adjusted HR: 0.54; 95% CI 0.14–2.12), myocardial infarction (adjusted HR: 0.77, 95% CI 0.49–1.19) and ischemic stroke (adjusted HR: 1.15; 95% CI 0.80–1.65), but a lower risk of heart failure (adjusted HR: 0.68; 95% CI 0.49–0.95). Conclusion The risk of cardiovascular events was similar between dapagliflozin and empagliflozin new users, but dapagliflozin may have a better outcome in the reduction of heart failure in type 2 diabetes patients. Future prospective studies are required to confirm the findings.

Clinical effectiveness study of SGLT2 inhibitors as added-on therapy for 149 insulin treated type 2 diabetes patients

2016 ◽  
Vol 120 ◽  
pp. S122-S123
Author(s):  
Yuan-Ching liu ◽  
Cheng-Wei Lin ◽  
I-Ying Chiu ◽  
Hsiao-Wei Lu ◽  
Cheng-Liang Chi ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Clinical Effectiveness ◽  
Sglt2 Inhibitors ◽  
Effectiveness Study ◽  
Diabetes Patients

scholarly journals Euglycemic diabetic ketoacidosis in type 2-diabetes mellitus treated with SGLT2 inhibitors - a report on two cases

2019 ◽  
Author(s):  
Antonio Burgio ◽  
Maurizio Alletto ◽  
Salvatore Amico ◽  
Umberto Castiglione ◽  
Giovanni Fulco ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Sglt2 Inhibitors ◽  
Blood Gas ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Arterial Blood Gas Analysis

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a new second-line medication in the management of hyperglycemia in type 2 diabetes. These drugs can be associated with the development of diabetic ketoacidosis (DKA) with normal or moderately increased blood glucose levels. This is a life-threatening clinical condition termed euglycemic DKA, of which the diagnosis can be delayed due to the relative euglycemia. We report on two patients with type 2 diabetes who presented to the Emergency Department with malaise, nausea and vomiting. Both patients had been taking dapagliflozin for at least six months. A risk factor for the development of ketoacidosis, namely heavy alcohol consumption, was found in one of the patients. Arterial blood gas analysis showed severe metabolic acidosis with increased anion gap, positive serum and urine ketones and normal arterial lactate. The patients were treated in Internal Medicine with intravenous fluids, insulin, sodium bicarbonate and potassium. Dapagliflozin was stopped. Both patients recovered uneventfully. Even in the absence of significant hyperglycemia, accurate interpretation of arterial blood gas analysis and serum ketones should lead to correct diagnosis of euDKA.

scholarly journals Paradoxical Diabetic Ketoacidosis in a Type 2 Diabetes patient on Dapagliflozin: A Brief Case Report

2021 ◽  
Author(s):  
Venkata Vinod Kumar Matli
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Diabetic Ketoacidosis ◽  
Diabetes Patient ◽  
Glucose Levels ◽  
Normal Glucose ◽  
Euglycemic Diabetic Ketoacidosis ◽  
Insulin Replacement

A 48-year -old male patient with Type 2 diabetes mellitus(T2D) on insulin replacement therapy, glipizide and Dapagliflozin admitted for generalized weakness found him in euglycemic diabetic ketoacidosis which means normal or near normal glucose levels with high anion gap metabolic acidosis recovered on insulin drip per DKA protocol.

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