Abstract
Background: Sodium-Glucose Co-Transporter-2 Inhibitors (SGLT-2i) have been associated with euglycemic diabetic ketoacidosis (EuDKA). The pathophysiology is related to decrease insulin secretion given glucosuria and lower insulin to glucagon ratio, resulting in enhanced lipolysis and ketogenesis at a lower glucose level. SGLT-2i may unmask underlying undiagnosed type-1 diabetes/Latent Autoimmune Diabetes of the Adult (LADA).
Objective: (1)To describe the frequency and clinical characteristics of SGLT-2i associated EuDKA at a Canadian tertiary care centre. (2)To identify the most common underlying diabetes-type associated with EuDKA.
Methods: A chart review identified patients with SGLT-2i-associated EuDKA from June 2015 to May 2019 who presented to a Canadian tertiary care centre. Clinical characteristics include age, gender, diabetes type, SGLT-2i drug prescribed, laboratory results at the time of EuDKA and possible precipitants were reviewed. Pancreatic autoantibodies (anti-GAD-65, anti-islet cell, IA-2, and insulin antibodies) were measured to screen for the possibility of undiagnosed LADA.
Results: Between June 2015 to May 2019, there were 647 DKA events of which 43 were related to SGLT-2i (Prevalence 6.64%). Canagliflozin was the most common SGLT-2i (53.5%) followed by Empagliflozin (34.9%). The most common precipitant was infection (16.3%), followed by surgery (14%). At presentation, average blood glucose was 14.95±12.51 mmol/L, pH 7.23±0.16, HCO3 12.86 ± 5.51 mmol/L, potassium 4.40±0.86 mmol/L and anion-gap 22.05±5.51 mmol/L. Average HbA1c was 9.2%±2.10 and BMI was 29.34±4.49. Twenty patients had pancreatic autoantibodies testing and seven were positive (35%), most commonly anti-GAD-65 (71.4%). As a result, seven patients were diagnosed with LADA who were previously diagnosed with type-2 diabetes. Out of the 7 patients with LADA, 2 had a positive family history of type-1 diabetes.
Conclusion: SGLT-2i associated EuDKA could unmask underlying LADA. Further studies are warranted to determine if routine pancreatic antibodies should be drawn for diabetes typing prior to prescribing or at presentation of SGLT-2i associated EuDKA.
Clinical characteristics, outcome and early induction deaths in patients with acute promyelocytic leukaemia: a five-year experience at a tertiary care centre