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Sglt2 Inhibitors And Dka

Euglycemic Dka Secondary To Sglt2 Inhibitors

Euglycemic Dka Secondary To Sglt2 Inhibitors

Authors: Priyanka Kailash (MS-4, Campbell University School of Osteopathic Medicine), Kevin Weaver, DO (Program Director, Lehigh Valley Health Network), and Krystle Shafer, MD (Attending Physician, York Hospital) // Edited by: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UT Southwestern Medical Center / Parkland Memorial Hospital) and Brit Long, MD (@long_brit) A 35-year-old male with a past medical history of type 2 diabetes arrives at the Emergency Department (ED) with altered mental status, nausea, vomiting, and diffuse abdominal pain that started 10 hours ago. The patient was recently started on an SGLT2 inhibitor. On examination, the patient is tachycardic (HR 126) and tachypneic (RR 25), with normal blood pressure (110/90). He is further noted to have dry mucous membranes and poor skin turgor. Blood glucose is noted to be 140 mg/dl, serum ketones 6.2 mmol/L, and arterial pH of 6.9. The patient is diagnosed with euglycemic DKA and quickly admitted to ICU for treatment. Pathogenesis of Typical DKA Two major complications from type 1 diabetes mellitus and type 2 diabetes mellitus are diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). DKA is typically seen in younger individuals, while HHS is typically seen in older patients(1). In the pathogenesis of typical DKA, the body experiences a starved state. Insulin deficiency (either through decreased production or decrease sensitivity) leads to the inactivation of GLUT4 receptors on cells. GLUT4 receptors function to help transport glucose molecules into cells so that it can be converted into energy. Without GLUT4 receptor activation, the glucose entry into cells remains shut. Thus, the cells start to experience a starved state. To compensate, the body activates an alternative energy pathway †Continue reading >>

Sglt2 Inhibitorassociated Diabetic Ketoacidosis: Clinical Review And Recommendations For Prevention And Diagnosis - Sciencedirect

Sglt2 Inhibitorassociated Diabetic Ketoacidosis: Clinical Review And Recommendations For Prevention And Diagnosis - Sciencedirect

Volume 38, Issue 12 , December 2016, Pages 2654-2664.e1 SGLT2 Inhibitorassociated Diabetic Ketoacidosis: Clinical Review and Recommendations for Prevention and Diagnosis Author links open overlay panel Ronald M.GoldenbergMD1 Sodium-glucose cotransporter 2 (SGLT2) inhibitors are the newest class of antihyperglycemic agents available on the market. Regulator warnings and concerns regarding the risk of developing diabetic ketoacidosis (DKA), however, have dampened enthusiasm for the class despite the combined glycemic, blood pressure, and occasional weight benefits of SGLT2 inhibitors. With the goal of improving patient safety, a cross-Canada expert panel and writing group were convened to review the evidence to-date on reported SGLT2 inhibitorrelated DKA incidents and to offer recommendations for preventing and recognizing patients with SGLT2 inhibitorassociated DKA. Reports covering DKA events in subjects taking SGLT2 inhibitors that were published in PubMed, presented at professional conferences, or in the public domain from January 2013 to mid-August 2016 were reviewed by the group independently and collectively. Practical recommendations for diagnosis and prevention were established by the panel. DKA is rarely associated with SGLT2 inhibitor therapy. Patients with SGLT2 inhibitorassociated DKA may be euglycemic (plasma glucose level <14 mmol/L). DKA is more likely in patients with insulin-deficient diabetes, including those with type 2 diabetes, and is typically precipitated by insulin omission or dose reduction, severe acute illness, dehydration, extensive exercise, surgery, low-carbohydrate diets, or excessive alcohol intake. SGLT2 inhibitorassociated DKA may be prevented by withholding SGLT2 inhibitors when precipitants develop, avoiding insulin omission or inappr Continue reading >>

Understanding Sglt2 Inhibitors' Diabetic Ketoacidosis Risk

Understanding Sglt2 Inhibitors' Diabetic Ketoacidosis Risk

Deepali Dixit, PharmD, BCPS, is a Clinical Assistant Professor at Ernest Mario School of Pharmacy and a Clinical Critical Care Pharmacist in the Medical Intensive Care Unit at Robert Wood Johnson University Hospital. Dr. Dixit has been involved in multiple committees and in leadership positions in regional and national pharmacy and organizations. Dr. Dixit's research interests include sedation and delirium in the critically ill, infectious disease, alcohol withdrawal syndrome, chronic obstructive pulmonary disease, and patient safety. This article was collaboratively written with Shannon Anthony, PharmD Candidate. In May 2015, the FDA issued a warning about the risk of developing diabetic ketoacidosis while using SGLT2 inhibitors. That December, the FDA updated the drugs’ labels to include warnings about developing ketoacidosis even with near-normal blood glucose levels.1 SGLT2 inhibitors lower blood glucose levels by decreasing renal glucose reabsorption, which increases urinary glucose excretion.2 Three drugs in this class are currently available in the United States: canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance).1 These medications are approved for managing type 2 diabetes, although they’re increasingly used off-label to treat type 1 diabetes (T1D), and trials are currently being conducted to evaluate their efficacy for this potential indication.3 Diabetic ketoacidosis (DKA) develops most frequently in T1D patients secondary to omission or decreased dosage of insulin, acute illness, or a recent surgical procedure.4 The typical clinical presentation includes hyperglycemia (>250mg/dL), anion-gap acidosis, and elevated plasma and urine ketones.3 Early diagnosis and management of ketoacidosis is vital. The cornerstone DKA treatment Continue reading >>

Euglycemic Diabetic Ketoacidosis Associated With Sodium-glucose Cotransporter-2 Inhibitor Use: A Case Report And Review Of The Literature

Euglycemic Diabetic Ketoacidosis Associated With Sodium-glucose Cotransporter-2 Inhibitor Use: A Case Report And Review Of The Literature

International Journal of Emergency Medicine The sodium-glucose cotransporter-2 (SGLT2) inhibitors are the newest class of anti-hyperglycemic medications used in the treatment of diabetes mellitus. Their increasing use has been driven by their apparent cardiovascular and renal benefits. They have been associated with a small but significantly increased risk of diabetic ketoacidosis (DKA). Many of the cases of DKA associated with SGLT2 inhibitor use present with normal or minimally elevated serum glucose levels, often delaying the diagnosis. A 44-year-old woman with diabetes mellitus presented to our emergency department complaining of 3 days of generalized weakness. The SGLT2 inhibitor canagliflozin had been added to her medication regimen 4 weeks earlier, and she had stopped using insulin 2 weeks prior to presentation. Laboratory evaluation revealed a metabolic acidosis with an elevated anion gap and the presence of serum acetone, despite a minimally elevated serum glucose of 163 mg/dL. The patient was treated for euglycemic DKA with intravenous infusions of insulin and dextrose, with resolution of her symptoms in 3 days. The SGLT2 inhibitors are a novel class of anti-hyperglycemic medications that are being used with increasing frequency in the treatment of diabetes mellitus. They are associated with a small but significantly increased risk of DKA. Many of the patients presenting with DKA associated with SGLT2 inhibitor use will have normal or minimally elevated serum glucose levels. This unusual presentation of DKA can be diagnostically challenging. The American Diabetes Association has defined diabetic ketoacidosis (DKA) with the following diagnostic criteria: metabolic acidosis (arterial pH < 7.3 and sodium bicarbonate < 18 mmol/L), ketosis (ketonemia or ketonuria) Continue reading >>

Sglt2 Inhibitors May Predispose To Ketoacidosis

Sglt2 Inhibitors May Predispose To Ketoacidosis

SGLT2 Inhibitors May Predispose to Ketoacidosis Diabetes, Endocrinology, and Obesity Branch (S.I.T., J.E.B., K.I.R.), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892; Division of Diabetes, Endocrinology, and Nutrition (S.I.T.), Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland 21201 Address all correspondence and requests for reprints to: Simeon I. Taylor, MD, PhD, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Mail Stop 1453, 9000 Rockville Pike, Bethesda, MD 20892. Search for other works by this author on: Diabetes, Endocrinology, and Obesity Branch (S.I.T., J.E.B., K.I.R.), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892; Search for other works by this author on: Diabetes, Endocrinology, and Obesity Branch (S.I.T., J.E.B., K.I.R.), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892; Search for other works by this author on: The Journal of Clinical Endocrinology & Metabolism, Volume 100, Issue 8, 1 August 2015, Pages 28492852, Simeon I. Taylor, Jenny E. Blau, Kristina I. Rother; SGLT2 Inhibitors May Predispose to Ketoacidosis, The Journal of Clinical Endocrinology & Metabolism, Volume 100, Issue 8, 1 August 2015, Pages 28492852, Sodium glucose cotransporter 2 (SGLT2) inhibitors are antidiabetic drugs that increase urinary excretion of glucose, thereby improving glycemic control and promoting weight loss. Since approval of the first-in-class drug in 2013, data have emerged suggesting that these drugs increase the risk of di Continue reading >>

Understanding Sglt2 Inhibitors' Diabetic Ketoacidosis Risk

Understanding Sglt2 Inhibitors' Diabetic Ketoacidosis Risk

Understanding SGLT2 Inhibitors' Diabetic Ketoacidosis Risk This article was collaboratively written withShannon Anthony, PharmD Candidate. In May 2015, the FDA issued a warning about the risk of developing diabetic ketoacidosis while using SGLT2 inhibitors. That December, the FDA updated the drugs labels to include warnings about developing ketoacidosis even with near-normal blood glucose levels.1 SGLT2 inhibitors lower blood glucose levels by decreasing renal glucose reabsorption, which increases urinary glucose excretion.2Three drugs in this class are currently available in the United States: canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance).1 These medications are approved for managing type 2 diabetes, although theyre increasingly used off-label to treat type 1 diabetes (T1D), and trials are currently being conducted to evaluate their efficacy for this potential indication.3 Diabetic ketoacidosis (DKA) develops most frequently in T1D patients secondary to omission or decreased dosage of insulin, acute illness, or a recent surgical procedure.4The typical clinical presentation includes hyperglycemia (>250mg/dL), anion-gap acidosis, and elevated plasma and urine ketones.3 Early diagnosis and management of ketoacidosis is vital. The cornerstone DKA treatment is fluid replacement, insulin therapy, and correction of electrolyte imbalances.4 In the DKA cases reported with SGLT2 inhibitors, patients had an atypical presentation of DKA resulting in delayed diagnosis and treatment. Patients presented euglycemic or with only slightly elevated blood glucose levels.1,3,5 An analysis of 9 patients who experienced an episode of DKA while on an SGLT2 inhibitor showed their range of blood glucose levels upon presentation was 96 to 224 mg/dL.3Based on t Continue reading >>

Sglt2 Inhibition And Ketoacidosis Should We Be Concerned? | Panicker Rajeev | British Journal Of Diabetes

Sglt2 Inhibition And Ketoacidosis Should We Be Concerned? | Panicker Rajeev | British Journal Of Diabetes

SGLT2 inhibition and ketoacidosis should we be concerned? Obesity and Endocrinology Research Group, Institute of Ageing and Chronic Disease, University of Liverpool Address for correspondence: Professor John PH Wilding Obesity and Endocrinology Research Group, University of Liverpool, Clinical Sciences Centre, Aintree University Hospital NHS Foundation Trust, SGLT2 inhibitors represent a novel class of oral glucose- lowering treatment that addresses some important unmet clinical needs in the treatment of type 2 diabetes, specifically weight reduction and a low propensity to cause hypoglycaemia. SGLT2 inhibition lowers the renal threshold for glucose excretion, resulting in renal glycosuria, a shift in substrate utilisation from carbohydrate to fat oxidation and hyperglucagonaemia; this poses a theoretical risk for ketoacidosis (including euglycaemic ketoacidosis) in the presence of other precipitating factors, especially reduction in insulin doses or low carbohydrate intake. There have been reports of several cases of ketoacidosis, mostly euglycaemic, and in people with type 1 or type 2 diabetes. Subsequent to this there were warnings from regulatory bodies (FDA and EMEA). In this article, we examine the reports of ketoacidosis associated with SGLT2 inhibition and try to explain the intrinsic pathophysiological mechanisms associated with this class of drugs which might contribute to ketoacidosis. The implications of these for clinical practice are summarised with key messages to health care providers. Key words: SGLT2 inhibitors, ketoacidosis, type 2 diabetes, mechanisms, clinical practice SGLT2 inhibitors are a new class of drugs for the treatment of type 2 diabetes that act by inhibiting renal glucose reabsorption. They have been adopted rapidly into clinical practic Continue reading >>

Sglt2 Inhibitors And Diabetic Ketoacidosis: Data From The Fda Adverse Event Reporting System.

Sglt2 Inhibitors And Diabetic Ketoacidosis: Data From The Fda Adverse Event Reporting System.

SGLT2 inhibitors and diabetic ketoacidosis: data from the FDA Adverse Event Reporting System. Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy. [email protected] Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy. Diabetologia. 2017 Aug;60(8):1385-1389. doi: 10.1007/s00125-017-4301-8. Epub 2017 May 12. AIMS/HYPOTHESIS: Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are indicated for the treatment of type 2 diabetes and may also improve glucose control in type 1 diabetes. In 2015, regulatory agencies warned that SGLT2i may favour diabetic ketoacidosis (DKA). We provide a detailed analysis of DKA reports in which an SGLT2i was listed among suspect or concomitant drugs in the US Food and Drug Administration Adverse Event Reporting System (FAERS). METHODS: We first analysed the entire public FAERS up to September (third quarter [Q3]) 2016 to extract the number of reports, background indications and concomitant medications, and to calculate proportional reporting ratios (PRRs) and safety signals. We then mined single FAERS files from the first quarter (Q1) of 2014 to 2016 Q3 to obtain detailed information on DKA reports. RESULTS: The FAERS database contains >2500 DKA reports in which SGLT2i are listed as suspect or concomitant drugs. The PRR of DKA in reports including vs those not including an SGLT2i and having a diabetes indication was 7.9 (95% CI 7.5, 8.4) and was higher for type 1 diabetes. Several concomitant conditions were less prevalent in DKA reports with SGLT2i vs DKA reports filed for other drugs. A detailed analysis of 2397 DKA reports for SGLT2i from 2014 Q1 to 2016 Q3 revealed a predominance of women, an extremely wide range of age and body weight, and a highly variable durat Continue reading >>

Report Compiles Data On Diabetic Ketoacidosis With Sglt2 Inhibitors

Report Compiles Data On Diabetic Ketoacidosis With Sglt2 Inhibitors

Report Compiles Data on Diabetic Ketoacidosis With SGLT2 Inhibitors Report Compiles Data on Diabetic Ketoacidosis With SGLT2 Inhibitors While rare, diabetic ketoacidosis occurs overwhelmingly in patients taking SGLT2 inhibitors with type 2 diabetes, according to the analysis from 3 North Carolina medical schools. A data analysis in Diabetes Care finds that diabetic ketoacidosis (DKA) in patients taking sodium glucose co-transporter-2 (SGLT2) inhibitors occurs most often among patients taking the drug for type 2 diabetes (T2D), the condition for which they are FDA approved. The report, using data from Wake Forest School of Medicine, the University of North Carolina School of Medicine, and Duke University School of Medicine, tries to shed light on which patients are at risk for DKA while taking the drugs, which have quickly become one of the most prescribed second-line therapies for T2D. DKA occurs when the body produces high levels of blood acids called ketones. When the body lacks enough insulin, it begins to break down fat as fuel, causing ketones to build up in the blood. SGLT2 inhibitors work by causing the body to excrete excess glucose in the urine. SGLT2 inhibitors are also being studied in patients with type 1 diabetes (T1D), and the researchers state that some of the early reports of DKA occurred in off-label usage with this population. But the vast majority of cases, though rare, occur in patients with T2D. The analysis of the 3 North Carolina medical schools found this to be true in 74% of the cases in its records. In June, the FDA strengthened an earlier warning about the risk of DKA for the drug class. This new analysis found 39 cases of DKA among 11,197 people with prescriptions for SGLT2 inhibitors. Of these, 26 patients had glucose 300 mg/dL, with a mean Continue reading >>

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As you were browsing PracticeUpdate, something about your browser made us think you were a bot. There are a few reasons this might happen: You're a power user moving through this website with super-human speed. You've disabled JavaScript in your web browser. A third-party browser plugin, such as Ghostery or NoScript, is preventing JavaScript from running. Additional information is available in this . After completing the CAPTCHA below, you will immediately regain access to PracticeUpdate. ​ You reached this page when attempting to access from 35.193.81.74 on 2018-01-13 05:57:24 UTC. Trace: 648a5def-a540-4407-90c1-5bc530ebec30 via 020cd700-68e4-4328-9c63-287de9f74976 Continue reading >>

Sglt2 Inhibitors Double The Risk For Diabetic Ketoacidosis

Sglt2 Inhibitors Double The Risk For Diabetic Ketoacidosis

SGLT2 Inhibitors Double the Risk for Diabetic Ketoacidosis The risk of developing diabetic ketoacidosis (DKA) among type 2 diabetes patients initiating a sodiumglucose cotransporter 2 (SGLT2) inhibitor medication is about double that seen among patients starting a dipeptidyl peptidase-4 (DPP-4) inhibitor, but the overall risk is still low, new research suggests. Findings from the largest study conducted to date to investigate the issue were published as a research letter in the June 8 issue of the New England Journal of Medicine by Michael Fralick, MD, and colleagues at the Brigham and Women's Hospital, Boston, Massachusetts. "We found a doubling in the risk of DKA, which sounds frightening, but the absolute risk is quite small.I still think this is a very good class of medications and for certain patients will continue to be. Now we just have a little more information to add to the discussion when the risks and benefits are being considered," Dr Fralick told Medscape Medical News. He estimates that between 5 and 8 patients per 1000 initiating SGLT2 inhibitors will develop DKA. And he advisesthat patients be strictly monitored for signs of DKA after starting on SGLT2 inhibitors, noting, "This is something that can happen relatively quickly, so that's why I think it's important right after patients are started on these drugs that they're closely monitored and the clinician considers ordering bloodwork." But overall, Dr Fralick, a general internist, supports use of the SGLT2 inhibitor class for selected patients with type 2 diabetes, given the recent results from the Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients (EMPA-REG OUTCOME) study showing reduction in cardiovascular deaths, as well as renal protection , with empagliflozin (Ja Continue reading >>

Sglt2 Inhibitors Tied To Ketoacidosis, Limb Amputation In Diabetics

Sglt2 Inhibitors Tied To Ketoacidosis, Limb Amputation In Diabetics

SGLT2 inhibitors tied to ketoacidosis, limb amputation in diabetics An observational study of nearly 35,000 Scandinavian patients with type 2 diabetes (T2D) has found sodium-glucose cotransporter 2 (SGLT2) inhibitors, a class of prescription drugs approved by the FDA to lower blood sugar in adults with T2D, may almost double patients risks of lower limb amputation and diabetic ketoacidosis compared to glucagon-like peptide 1 (GLP1) receptor agonists. An observational study of nearly 35,000 Scandinavian patients with type 2 diabetes (T2D) has found sodium-glucose cotransporter 2 (SGLT2) inhibitors, a class of prescription drugs approved by the FDA to lower blood sugar in adults with T2D, may almost double patients risks of lower limb amputation and diabetic ketoacidosis compared to glucagon-like peptide 1 (GLP1) receptor agonists. In a paper published in The BMJ , senior researcher Bjorn Pasternak, MD, PhD, and colleagues said SGLT2 inhibitors, which include medications like canagliflozin, dapagliflozin and empagliflozin, are becoming an increasingly popular class of drugs for the treatment of T2D. SGLT2s lower blood glucose levels by encouraging glucose loss through the kidneys, but theyve provoked concern in the past from the FDA. Case reports to the U.S. FDA Adverse Event Reporting System have indicated that SGLT2 inhibitors could cause diabetic ketoacidosis, acute kidney injury and serious urinary tract infection, Pasternak and coauthors wrote. SGLT2 inhibitors increase blood viscosity by inducing mild diuresis, which suggests that the risk of venous thromboembolism could be increased. The FDA is also investigating reports linking SGLT2s to acute pancreatitis, they said. Pasternak and his team evaluated the potential risks of the drug class by comparing data from 17 Continue reading >>

Risk Of Diabetic Ketoacidosis After Initiation Of An Sglt2 Inhibitor

Risk Of Diabetic Ketoacidosis After Initiation Of An Sglt2 Inhibitor

To the Editor: Inhibitors of sodium–glucose cotransporter 2 (SGLT2) decrease plasma glucose by blocking the reabsorption of glucose at the proximal tubule.1,2 Case reports have suggested that SGLT2 inhibitors may be associated with an increased risk of diabetic ketoacidosis, which led to a warning from the Food and Drug Administration (FDA) in May 2015.3,4 The objective of our study was to assess the risk of diabetic ketoacidosis after the initiation of an SGLT2 inhibitor. Using a large claims database of commercially insured patients in the United States (Truven MarketScan), we identified a cohort of adult patients (≥18 years of age) who had newly started treatment with either an SGLT2 inhibitor or a dipeptidyl peptidase-4 (DPP4) inhibitor between April 1, 2013, and December 31, 2014 (before the FDA warning). DPP4 inhibitors were chosen as the comparator medication because they are similarly used as a second-line treatment for diabetes but have no known association with diabetic ketoacidosis. We excluded patients with human immunodeficiency virus infection, end-stage renal disease, cancer, type 1 diabetes, or past diabetic ketoacidosis. Our primary outcome was hospitalization for diabetic ketoacidosis (using the primary position code of the International Classification of Diseases, Ninth Revision) within 180 days after the initiation of an SGLT2 inhibitor or a DPP4 inhibitor. We censored data for patients at the time that they discontinued the initial medication, had the outcome, lost insurance coverage, or died. We used 1:1 propensity-score matching to balance 46 characteristics of the patients and Cox regression to estimate hazard ratios and 95% confidence intervals for diabetic ketoacidosis within 180 days after treatment initiation. Predefined sensitivity analy Continue reading >>

Sglt2 Inhibitors Double The Risk For Diabetic Ketoacidosis. N Engl J Med

Sglt2 Inhibitors Double The Risk For Diabetic Ketoacidosis. N Engl J Med

SGLT2 Inhibitors Double the Risk for Diabetic Ketoacidosis. N Engl J Med The risk of developing diabetic ketoacidosis (DKA) among type 2 diabetes patients initiating a sodiumglucose cotransporter 2 (SGLT2) inhibitor medication is about double that seen among patients starting a dipeptidyl peptidase-4 (DPP-4) inhibitor, but the overall risk is still low, new research suggests. Findings from the largest study conducted to date to investigate the issue werepublishedas a research letter in the June 8 issue of theNew England Journal of Medicineby Michael Fralick, MD, and colleagues at the Brigham and Women's Hospital, Boston, Massachusetts. "We found a doubling in the risk of DKA, which sounds frightening, but the absolute risk is quite small....I still think this is a very good class of medications and for certain patients will continue to be. Now we just have a little more information to add to the discussion when the risks and benefits are being considered," Dr Fralick toldMedscape Medical News. He estimates that between 5 and 8 patients per 1000 initiating SGLT2 inhibitors will develop DKA. And he advisesthat patients be monitored for signs of DKA or full information to thew patients of the symtoms of DKA to seek help if DKA appears after starting on SGLT2 inhibitors, noting, "This is something that can happen relatively quickly, so that's why I think it's important right after patients are started on these drugs that they're closely monitored and the clinician considers ordering bloodwork." But overall, Dr Fralick, a general internist, supports use of the SGLT2 inhibitor class for selected patients with type 2 diabetes, given the recent results from theEmpagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients(EMPA-REG OUTCOME) study showing Continue reading >>

Sglt2 Inhibitors And Diabetic Ketoacidosis: What's Behind The Fda Warning

Sglt2 Inhibitors And Diabetic Ketoacidosis: What's Behind The Fda Warning

With commentary by Yehuda Handelsman, MD, FACP, FACE, FNLA, an endocrinologist in private practice in Tarzana, CA, Medical Director and Principal Investigator of the Metabolic Institute of America and President of the American College of Endocrinology People with diabetes who take blood sugar-lowering drugs called SGLT2 inhibitors were recently warned by the U.S. Food and Drug Administration (FDA) that they should watch for signs of a life-threatening condition called diabetic ketoacidosis. canagliflozin (Invokana) dapagliflozin (Farxiga) empagliflozin (Jardiance) as well as the combination pills: canagliflozin plus metformin (Invokamet) dapagliflozin plus metformin extended-release (Xigduo XR) empagliflozin plus linagliptin (Glyxambi). “Diabetic ketoacidosis (DKA) can be deadly,” says Amy Hess-Fischl, MS, RD, LDN, BC-ADM, CDE, an advanced practice dietitian at the University of Chicago Kovler Diabetes Center and a member of EndocrineWeb’s advisory board. “DKA is usually more of a concern for people with type 1 diabetes, but this warning is for people with type 2 diabetes who are taking the SGLT2 inhibitors, as well as people with type 1 diabetes who take these medications off label. DKA — dangerously high acid levels in the bloodstream — happens when your body breaks down fat instead of glucose for energy, releasing acidic compounds called ketones. Early symptoms include thirst, frequent urination and sweet, fruity breath, Hess-Fischl says. You may feel tired and confused, and develop nausea, stomach pain, vomiting and difficulty breathing. “If you notice symptoms, call your doctor immediately. But if you’re vomiting, can’t catch your breath or are concerned, go to the emergency room,” she says. Putting the Risk in Perspective The FDA warning, relea Continue reading >>

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