Hamblin PS, et al. - In this retrospective, multi-center, controlled cohort study, researchers identified the incidence, characteristics and results of diabetic ketoacidosis (DKA) in sodium glucose cotransporter 2 inhibitors (SGLT2i)-users vs non-users with type 2 diabetes. Findings suggested that SGLT2i users were more likely than non-SGLT2i users to develop DKA as an inpatient. The use of SGLT2i was related to a small but substantially increased risk of DKA.

Methods

• From September 1, 2015 to October 31, 2017, all public hospitals in Melbourne and Geelong (combined population 5 million), Australia.
• The study sample consisted of consecutive cases of DKA that occurred in the community, or during the course of hospital admission, in patients with type 2 diabetes.
• In SGLT2i users vs non-users: Odds ratio of DKA developing during hospital admission and Incidence of DKA

Results

• According to results, there have been 162 cases of DKA (37 SGLT2i users and 125 non-SGLT2i users) with a physician-adjudicated diagnosis of type 2 diabetes.
• Investigators observed that DKA developed during the course of inpatient admission in 14 (38%) SGLT2i users vs two (2%) non-SGLT2i users, (odds ratio 37.4 [95% CI 8.0-175.9], p<0.0001).
• Data reported that the diabetic ketoacidosis incidence was 1.02/1000 (95% CI 0.74-1.41/1000) in SGLT2i users vs 0.69/1000 (0.58-0.82/1000) in non-SGLT2i users (odds ratio 1.48 (1.02-2.15), p=0.037).
• They found that 15 SGLT2i users (41%) had peak blood glucose <250 mg/dl (14 mmol/l) compared to one (0.8%) non-SGLT2i user (p < 0.001).