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Sglt2 Inhibitors And Dka

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 >>

Euglycemic Diabetic Ketoacidosis In The Setting Of Sglt2 Inhibitor Use And Hypertriglyceridemia: A Case Report And Review Of Literature

Euglycemic Diabetic Ketoacidosis In The Setting Of Sglt2 Inhibitor Use And Hypertriglyceridemia: A Case Report And Review Of Literature

Euglycemic Diabetic Ketoacidosis in the Setting of SGLT2 Inhibitor Use and Hypertriglyceridemia: A Case Report and Review of Literature Monitoring Editor: Alexander Muacevic and John R Adler 1 Internal Medicine, University of Connecticut Health Center, Farmington, USA Received 2019 Mar 18; Accepted 2019 Apr 3. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. We describe the case report of a patient with euglycemic diabetic ketoacidosis (euDKA), in the setting of sodium-glucose cotransporter-2 (SGLT2) inhibitor use, complicated by hypertriglyceridemia (HTG). A28-year-old female with a history of gestational diabetes mellitus and subsequent type 2 diabetes mellitus (T2DM) on dapagliflozin and metformin presented with a one-week history of polyuria, poor appetite, and vomiting. On admission, serum glucose was 111 mg/dl, bicarbonate 18 mmol/l, anion gap 20, triglycerides 508 mg/dL, and venous pH 7.27. Serum ketonelevels could not be assessed, as blood samples kept hemolyzing due to significant lipemia. Thepatient was initially admitted for starvation ketosis. However, serum chemistry obtained six hours after presentation revealed no change in theanion gap and a rise in triglycerides. She was treated with an insulin drip for euDKA and HTG with theresolution of theclinical picture. We performed a literature review of this topic and discuss the pathophysiology, diagnosis, management,and prevention of SGLT2-inhibitor-induced euDKA. Keywords: euglycemic dka, sglt2 inhibitor, dapagliflozin, euglycemic diabetic ketoacidosis Diabetic ketoacidosis (DKA) is a medical emergency characterized by the t Continue reading >>

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An Error Occurred Setting Your User Cookie This site uses cookies to improve performance. If your browser does not accept cookies, you cannot view this site. There are many reasons why a cookie could not be set correctly. Below are the most common reasons: You have cookies disabled in your browser. You need to reset your browser to accept cookies or to ask you if you want to accept cookies. Your browser asks you whether you want to accept cookies and you declined. To accept cookies from this site, use the Back button and accept the cookie. Your browser does not support cookies. Try a different browser if you suspect this. The date on your computer is in the past. If your computer's clock shows a date before 1 Jan 1970, the browser will automatically forget the cookie. To fix this, set the correct time and date on your computer. You have installed an application that monitors or blocks cookies from being set. You must disable the application while logging in or check with your system administrator. This site uses cookies to improve performance by remembering that you are logged in when you go from page to page. To provide access without cookies would require the site to create a new session for every page you visit, which slows the system down to an unacceptable level. This site stores nothing other than an automatically generated session ID in the cookie; no other information is captured. In general, only the information that you provide, or the choices you make while visiting a web site, can be stored in a cookie. For example, the site cannot determine your email name unless you choose to type it. Allowing a website to create a cookie does not give that or any other site access to the rest of your computer, and only the site that created the cookie can read it. Continue reading >>

Euglycemic Diabetic Ketoacidosis: The Clinical Concern Of Sglt2 Inhibitors

Euglycemic Diabetic Ketoacidosis: The Clinical Concern Of Sglt2 Inhibitors

Euglycemic diabetic ketoacidosis is a post market warning in patients with type 1 diabetes and type 2 diabetes treated with SGLT-2 inhibitors. We report a case of a 39-year-old obese female with presumed type 2 diabetes for seven years who presented to the emergency department with three days of nausea, vomiting, and abdominal pain. Due to previous total non-adherence with a prescribed insulin regimen, she was recently started on canagliflozin and liraglutide. The diagnosis of euDKA was missed in the initial evaluation as the blood glucose level was only 167 mg/dL. Further work up showed severe metabolic acidosis with an anion gap of 25 and positive ketones in the urine. She was treated successfully with dextrose water 5%/half normal saline and an insulin drip. As part of the work up, she tested positive for glutamic acid decarboxylase autoantibodies. Given the increasing utilization of SGLT-2 inhibitors and the fact that patients can present with near-normal glycemia, the diagnosis can be missed. Vigilance with the use of SGLT-2 inhibitors is necessary to decrease morbidity and potentially mortality particularly in patients with long-standing type 2 diabetes associated with marked β-cell insufficiency, type 1 diabetes mellitus, or latent autoimmune diabetes of adult onset. 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 >>

Recommendations Issued For Managing Sglt Inhibitor-associated Dka Risk In Type 1 Diabetes

Recommendations Issued For Managing Sglt Inhibitor-associated Dka Risk In Type 1 Diabetes

02-12-2019 | SGLT2 inhibitors | Highlight | News Recommendations issued for managing SGLT inhibitor-associated DKA risk in type 1 diabetes medwireNews: Experts have developed consensus recommendations for minimizing diabetic ketoacidosis (DKA) risk in patients with type 1 diabetes treated with sodium-glucose cotransporter (SGLT)inhibitors. These agents are increasingly being used off-label in type 1 diabetes management, and several SGLT inhibitors are currently under review by US Food and Drug Administration (FDA) and European regulatory agencies as an adjunct to insulin therapy in people with type 1 diabetes, say Christopher Parkin (CGParkin Communications, Inc., Boulder City, Nevada, USA) and co-authors. They explain that recent studies have demonstrated an increase in absolute DKA risk with SGLTinhibitor treatment, sometimes in patients with near-normal blood glucose levels, thus complicating the recognition/diagnosis of DKA and potentially delaying treatment. As reported in Diabetes Care , the international panel of 26clinicians and researchers developed their guidance based on evidence from randomized trials and their clinical experience. The recommendations stress that selecting appropriate patients for SGLTinhibitor therapy is critical for attenuating DKA risk. Parkin and colleagues say that the paramount criterion for patient selection is normal ketone levels, defined as blood concentration below 0.6mmol/L and negative urinary ketones, but individual patient factors, such as ability to follow ketone monitoring regimens, must also be taken into account. They specify that SGLTinhibitors should not be given to pregnant women with type 1 diabetes or patients using low-carbohydrate or ketogenic diets, and point out that those using an insulin pump are at increased D 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 >>

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 >>

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 >>

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 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 >>

Sglt2 Inhibitors: Updated Advice On The Risk Of Diabetic Ketoacidosis

Sglt2 Inhibitors: Updated Advice On The Risk Of Diabetic Ketoacidosis

Advice for healthcare professionals: When treating patients who are taking a sodium-glucose co-transporter 2 (SGLT2) inhibitor (canagliflozin, dapagliflozin, or empagliflozin): inform them of the signs and symptoms of diabetic ketoacidosis (DKA) – see below – and advise them to seek immediate medical advice if they develop any of these discuss the risk factors for DKA with patients (see below) discontinue treatment with the SGLT2 inhibitor immediately if DKA is suspected or diagnosed do not restart treatment with any SGLT2 inhibitor in patients who experienced DKA during use, unless another cause for DKA was identified and resolved interrupt treatment with the SGLT2 inhibitor in patients who are hospitalised for major surgery or acute serious illnesses; treatment may be restarted once the patient’s condition has stabilised Reports of diabetic acidosis EU medicines regulators have completed a review of DKA associated with SGLT2 inhibitor treatment; this article summarises the review’s recommendations. We published preliminary advice on this in June 2015. SGLT2 inhibitors are licensed for use in adults with type 2 diabetes to improve glycaemic control. Serious, life-threatening, and fatal cases of DKA have been reported in patients taking an SGLT2 inhibitor (canagliflozin, dapagliflozin, or empagliflozin). The EU review concluded that this side effect is rare (affecting between 1 in 1000 and 1 in 10,000 patients). Up to 26 February 2016, we had received 118 Yellow Card reports of DKA and associated reactions in patients taking an SGLT2 inhibitor in the UK. In several cases, blood glucose levels were only moderately elevated (eg <14mmol/L)—representing an atypical presentation for DKA, which could delay diagnosis and treatment. Therefore inform patients of the si Continue reading >>

Euglycemic Diabetic Ketoacidosis: A Predictable, Detectable, And Preventable Safety Concern With Sglt2 Inhibitors

Euglycemic Diabetic Ketoacidosis: A Predictable, Detectable, And Preventable Safety Concern With Sglt2 Inhibitors

The Case At Hand Recently, the U.S. Food and Drug Administration (FDA) issued a Drug Safety Communication that warns of an increased risk of diabetic ketoacidosis (DKA) with uncharacteristically mild to moderate glucose elevations (euglycemic DKA [euDKA]) associated with the use of all the approved sodium–glucose cotransporter 2 (SGLT2) inhibitors (1). This Communication was based on 20 clinical cases requiring hospitalization captured between March 2013 and June 2014 in the FDA Adverse Event Reporting System database. The scarce clinical data provided suggested that most of the DKA cases were reported in patients with type 2 diabetes (T2D), for whom this class of agents is indicated; most likely, however, they were insulin-treated patients, some with type 1 diabetes (T1D). The FDA also identified potential triggering factors such as intercurrent illness, reduced food and fluid intake, reduced insulin doses, and history of alcohol intake. The following month, at the request of the European Commission, the European Medicines Agency (EMA) announced on 12 June 2015 that the Pharmacovigilance Risk Assessment Committee has started a review of all of the three approved SGLT2 inhibitors (canagliflozin, dapagliflozin, and empagliflozin) to evaluate the risk of DKA in T2D (2). The EMA announcement claimed that as of May 2015 a total of 101 cases of DKA have been reported worldwide in EudraVigilance in T2D patients treated with SGLT2 inhibitors, with an estimated exposure over 0.5 million patient-years. No clinical details were provided except for the mention that “all cases were serious and some required hospitalisation. Although [DKA] is usually accompanied by high blood sugar levels, in a number of these reports blood sugar levels were only moderately increased” (2). Wit 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 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 glucose of 266 mg/dL. Symptoms reported included nausea and vomitin Continue reading >>

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