SGLT2 and DKA Hx

Q:  Sodium-glucose cotransporter 2 (SGLT2) inhibitors should not be used in patients with a prior history of diabetic ketoacidosis (DKA)?

A) True

B) False

Answer: A

The objective of this question is to enhance the wave of "euglycemic DKA" witnessed in ICUs in the last couple of years. SGLT2 inhibitors should be used with great caution in patients with Type 2 diabetes with eGFR <45 mL/min/1.73 m2, and a prior history of  DKA.

As the Sodium-glucose cotransporter 2 inhibitors mechanism of action is via kidney, it may cause some degree of dehydration. It should also be used with caution in patients who are using nonsteroidal anti-inflammatory drugs (NSAIDs), angiotensin-converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARBs), and diuretics. The combined therapy may predispose a patient to Acute Kidney Injury (AKI).

Three other major side effects are

• genitourinary tract bacterial and yeast infections
• bone loss and fracture
• lower extremity infection and amputation, particularly in patients with foot ulceration, neuropathy, foot deformity, and vascular disease

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References:

1. Halimi S, Vergès B. Adverse effects and safety of SGLT-2 inhibitors. Diabetes Metab. 2014 Dec;40(6 Suppl 1):S28-34. doi: 10.1016/S1262-3636(14)72693-X. PMID: 25554069.

2. Singh M, Kumar A. Risks Associated with SGLT2 Inhibitors: An Overview. Curr Drug Saf. 2018;13(2):84-91. doi: 10.2174/1574886313666180226103408. PMID: 29485006.

3. Pittampalli S, Upadyayula S, Mekala HM, Lippmann S. Risks vs Benefits for SGLT2 Inhibitor Medications. Fed Pract. 2018 Jul;35(7):45-48. PMID: 30766374; PMCID: PMC6368009.