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Sglt2 Inhibitors And Dka

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 >>

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 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 >>

Sglt2 Inhibitors And Dka In People With Type 1 Diabetes

Sglt2 Inhibitors And Dka In People With Type 1 Diabetes

SGLT2 Inhibitors and DKA in People With Type 1 Diabetes Treating type 1 diabetes with insulin alone can be a challenge. One fairly new class of drugs, SGLT2 inhibitors, appears to be an effective add-on treatment. It reduces blood glucose levels, body weight, and the amount of insulin patients need. Also, it does not increase the frequency ofhypoglycemia(low blood glucose levels) in people with either type 1 or type 2 diabetes. However, the drug may increase the risk of diabetic ketoacidosis (DKA), a dangerous form of extremehyperglycemia(high blood glucose levels) that can lead tocomaor even death. How real is that risk? A total 351 people with poorly controlled type 1 diabetes signed up for the study. All either took multiple daily injections of insulin or used an insulin pump, which continuously delivers insulin under the skin. The participants were randomly assigned to one of two groups for the 18-week study. One group took the study drug canagliflozin, an SGLT2 inhibitor, at 100 or 300 mg once a day. The other group was given a placebo, which resembled the treatment pill but had no active ingredients. The goal: to determine which group had a higher number of participants who experienced DKA. Canagliflozin, an SGLT2 inhibitor, appears to boost the risk of serious DKA, at least when taken at the higher dose. However, the patients monitored themselves for ketones throughout the study. That means it is possible that some of them made mistakes, which could have affected the results of the study. If you take canagliflozin, be aware of the potential risks and know how to monitor yourself for any changes in your ketone levels. Talk to your doctor about these concerns and be aware of the symptoms of DKA and the circumstances in which it is most likely to occur. Diabetic Ke 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 >>

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 >>

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 >>

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 >>

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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 Inhibitor-linked Diabetic Ketoacidosis Is Rare, But Severe

Sglt2 Inhibitor-linked Diabetic Ketoacidosis Is Rare, But Severe

SGLT2 Inhibitor-Linked Diabetic Ketoacidosis Is Rare, but Severe Many cases of sodium-glucose cotransporter-2 (SGLT2) inhibitor-associated diabetic ketoacidosis (DKA) are preventable, new research suggests. But physicians and patients are missing the signs and symptoms of this rare side effect or not even aware of the link and as a result, any cases are severe and one was fatal, according to this latest audit of Australian databases, published online February 13 in Diabetes Care by Emily J Meyer, MBBS, of the Royal Adelaide Hospital and University of Adelaide, Australia, and colleagues. As DKA was initially missed by both patients and physicians, likely due in part to relative euglycemia, this led to delayed treatment, say the researchers. However, "identifiable precipitants were often present, suggesting the potential for risk mitigation," Meyer and colleagues write. Stop SGLT2 Inhibitors for Acute Illness, Surgery The US Food and Drug Administration (FDA) first warned about the risk for DKA with SGLT2 inhibitors, a relatively new class of oral agents for type 2 diabetes, in 2015, and the European Medicines Agency followed suit in 2016. The phenomenon has also been reported several times in the literature, including in the New England Journal of Medicine in 2017. The advice has been, and the Australian authors agree, that SGLT2 inhibitors should be temporarily stoppedduring acute illness or surgery. The possibility of DKA should be considered in any patient taking one of the agents who presents with malaise, nausea, and/or vomiting, they add. The drug should be stopped and, if caught early, the patient given hydration, carbohydrates, and insulin to prevent progression to DKA. Also, Meyers and colleagues suggest excluding a diagnosis of autoimmune diabetes (type 1 or l 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 >>

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 >>

New Study Links Sglt2 Inhibitors To Increased Risk Of Diabetic Ketoacidosis

New Study Links Sglt2 Inhibitors To Increased Risk Of Diabetic Ketoacidosis

New study links SGLT2 inhibitors to increased risk of diabetic ketoacidosis New study links SGLT2 inhibitors to increased risk of diabetic ketoacidosis Benefits of metformin may involve gut bacteria 23 May 2017 The drug class SGLT2 inhibitors have again been linked with an increased risk of diabetic ketoacidosis (DKA) in a new study. SGLT2 inhibitors have been approved to treat type 2 diabetes in the UK since 2013, but regular links with DKA , a dangerous short-term complication of diabetes if left untreated, have persisted. In 2015 the US Food and Drug Administration (FDA) issued a warning about the drugs' association with DKA, and the Medicines and Healthcare Products Regulatory Agency last year urged healthcare professionals to test for raised ketones in patients with DKA symptoms, even if their blood glucose levels were near normal. In a new study scientists from Brigham and Women's Hospital found that patients treated with SGLT2s are twice as likely to experience DKA compared to another class of diabetes medication . However, the researchers stressed that this risk is still very rare: around one in every 1,000 patients will take an SGLT2 inhibitor will experience DKA. A total of 40,000 patients taking SGLT2 inhibitors were reviewed by the researchers, and compared to patients who took a different type of medication, DPP4 inhibitors . After 180 days, 55 SGLT2-treated patients had experienced DKA, compared to 26 of the DPP4 group. Lead author Dr Michael Fralik said that while DKA is uncommon amongst SGLT2 patients, doctors need to be on the lookout for signs and symptoms of DKA among patients. These symptoms include dehydration , rapid heartbeat and vomiting. "This is a side effect that's usually seen in patients with type 1 diabetes [...] - not type 2 diabetes - so 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 >>

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