Context. Numerous reports suggest an association between SGLT2 inhibitors and DKA. Since the use of these drugs for diabetes has increased dramatically, identification of patients at greatest risk of this life-threatening complication is essential. Objective. To describe the clinical and biochemical characteristics of all reported cases of DKA associated with SGLT2 inhibitor use in patients with type 2 diabetes mellitus and to identify potential risk factors. Design. A retrospective case series was conducted between March 2013 and August 2019 using an electronic medical record search algorithm. Results. 25 patients met the criteria for DKA associated with SGLT2i use (total of 29 cases), 15 were female, average age was 54.24 years, and mean diabetes duration was 8.76 years. The majority of the patients (23 patients) had no history of prior DKA. Average blood glucose concentrations at presentation were 298.9 ± 152.7 mg/dl. Interestingly, nearly half of the episodes (14) met the criteria of euglycemic DKA (glucose <250 mg/dl). Average anion gap values were 26.59 ± 6.15 mg/dl, bicarbonate values were 11.14 ± 5.57 mg/dl, and pH values were 7.16 ± 0.12. All had positive serum and urine ketones. The most common presenting symptoms were nausea, vomiting (18 cases), and abdominal pain (10 cases). Common precipitants were poor oral intake (18 cases) and infection (10 cases). A variety of drugs were prescribed along with an SGLT2i, and 11 of the patients were using insulin. None of the cases were fatal. Comparison between euglycemic DKA and hyperglycemic DKA did not identify any significant difference. A major limitation factor of the study was the lack of control group or comparison to other antiglycemic agents to assess the relative risk. Conclusions. The majority of SGLT2i-associated DKA cases occurred in patients with T2DM without prior episodes of DKA. The most common presenting symptoms were nausea, vomiting, and abdominal pain, while poor food intake and infection were the main precipitants. Clinicians should consider the possibility of DKA in SGLT2i-treated patients presenting with these symptoms, even in absence of marked hyperglycemia.

中文翻译：

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钠-葡萄糖协同转运蛋白2抑制剂相关的糖尿病酮症酸中毒29例临床及生化特征

上下文。许多报告表明 SGLT2 抑制剂与 DKA 之间存在关联。由于这些药物治疗糖尿病的使用急剧增加，因此识别出这种危及生命的并发症风险最大的患者至关重要。客观。描述与 2 型糖尿病患者使用 SGLT2 抑制剂相关的所有报告的 DKA 病例的临床和生化特征，并确定潜在的危险因素。设计。使用电子病历搜索算法在 2013 年 3 月至 2019 年 8 月期间进行了回顾性病例系列。结果。符合SGLT2i使用相关DKA标准的患者25例（共29例），其中女性15例，平均年龄54.24岁，平均糖尿病病程8.76年。大多数患者（23 名患者）既往没有 DKA 病史。就诊时的平均血糖浓度为 298.9 ± 152.7 mg/dl。有趣的是，近一半的发作 (14) 符合正常血糖 DKA 的标准（血糖 <250 mg/dl）。平均阴离子间隙值为 26.59 ± 6.15 mg/dl，碳酸氢盐值为 11.14 ± 5.57 mg/dl，pH 值为 7.16 ± 0.12。所有患者的血清和尿酮均呈阳性。最常见的症状是恶心、呕吐（18 例）和腹痛（10 例）。常见的诱因是摄入不良（18例）和感染（10例）。与 SGLT2i 一起开了多种药物，其中 11 名患者正在使用胰岛素。所有病例均未死亡。正常血糖 DKA 和高血糖 DKA 之间的比较没有发现任何显着差异。该研究的一个主要限制因素是缺乏对照组或与其他抗血糖药物的比较来评估相对风险。结论。大多数 SGLT2i 相关 DKA 病例发生在既往没有 DKA 发作的 T2DM 患者中。最常见的症状是恶心、呕吐和腹痛，而食物摄入不足和感染是主要诱因。即使没有明显的高血糖，临床医生也应考虑出现这些症状的 SGLT2i 治疗患者发生 DKA 的可能性。