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Brief Report Complications Diabetic Ketoacidosis as an Effect of Sodium-Glucose Cotransporter 2 Inhibitor: Real World Insights
Han-Sang Baek1orcid , Chaiho Jeong1, Yeoree Yang2, Joonyub Lee2, Jeongmin Lee3, Seung-Hwan Lee2, Jae Hyoung Cho2, Tae-Seo Sohn1, Hyun-Shik Son1, Kun-Ho Yoon2, Eun Young Lee2orcid

DOI: https://doi.org/10.4093/dmj.2024.0036 [Epub ahead of print]
Published online: June 10, 2024
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1Division of Endocrinology and Metabolism, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
2Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
3Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
Corresponding author:  Eun Young Lee,
Email: leyme@catholic.ac.kr
Received: 22 January 2024   • Accepted: 13 May 2024

One of the notable adverse effects of sodium-glucose cotransporter 2 (SGLT2) inhibitor is diabetic ketoacidosis (DKA) often characterized by euglycemia. In this retrospective review of patients with DKA from 2015 to 2023, 21 cases of SGLT2 inhibitorassociated DKA were identified. Twelve (57.1%) exhibited euglycemic DKA (euDKA) while nine (42.9%) had hyperglycemic DKA (hyDKA). More than 90% of these cases were patients with type 2 diabetes mellitus. Despite similar age, sex, body mass index, and diabetes duration, individuals with hyDKA showed poorer glycemic control and lower C-peptide levels compared with euDKA. Renal impairment and acidosis were worse in the hyDKA group, requiring hemodialysis in two patients. Approximately one-half of hyDKA patients had concurrent hyperosmolar hyperglycemic state. Common symptoms included nausea, vomiting, general weakness, and dyspnea. Seizure was the initial manifestation of DKA in two cases. Infection and volume depletion were major contributors, while carbohydrate restriction and inadequate insulin treatment also contributed to SGLT2 inhibitor-associated DKA. Despite their beneficial effects, clinicians should be vigilant for SGLT2 inhibitor risk associated with DKA.

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Baek HS, Jeong C, Yang Y, Lee J, Lee J, Lee SH, Cho JH, Sohn TS, Son HS, Yoon KH, Lee EY. Diabetic Ketoacidosis as an Effect of Sodium-Glucose Cotransporter 2 Inhibitor: Real World Insights. Diabetes Metab J. 2024 Jun 10. doi: 10.4093/dmj.2024.0036. Epub ahead of print.
Received: Jan 22, 2024; Accepted: May 13, 2024
DOI: https://doi.org/10.4093/dmj.2024.0036.

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