Kelmenson Daniel A, Burr Kelsey, Azhar Yusra, Reynolds Paul, Baker Chelsea A, Rasouli Neda
University of Colorado, Aurora, CO, USA.
J Investig Med High Impact Case Rep. 2017 Jun 8;5(2):2324709617712736. doi: 10.1177/2324709617712736. eCollection 2017 Apr-Jun.
Sodium-glucose cotransporter-2 (SGLT2) inhibitors improve glycemic control by a reversible inhibition of the sodium-glucose cotransporters in the renal proximal tubules resulting in increased urinary glucose. This unique mechanism, independent of insulin secretion and beta cell function, has made this class of medication desirable in patients with type 2 diabetes. However in May 2015, the US Food and Drug Administration issued a safety warning pertaining to the development of diabetic ketoacidosis (DKA) with the use of SGLT2 inhibitors. DKA associated with SGLT2 inhibitors frequently develops in the absence of hyperglycemia, which makes the diagnosis more challenging. Due to the reversible inhibition of SGLT2 by this class of medication, a quick recovery of glucosuria after cessation of medication is expected. In this article, we present a case of a 50-year-old woman with type 2 diabetes who developed euglycemic DKA after initiating therapy with canagliflozin. This case of DKA associated with SGLT2 inhibitor use was unique due to her hypoglycemic presentation and persistent glucosuria. SGLT2 inhibitors such as canagliflozin may predispose patients not only to diabetic ketoacidosis but also to prolonged glucosuria.
钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂通过可逆性抑制近端肾小管中的钠-葡萄糖协同转运蛋白，增加尿糖排泄，从而改善血糖控制。这种独特机制不依赖胰岛素分泌和β细胞功能，使得这类药物成为2型糖尿病患者的理想选择。然而，2015年5月，美国食品药品监督管理局发布了关于使用SGLT2抑制剂会引发糖尿病酮症酸中毒（DKA）的安全警告。与SGLT2抑制剂相关的DKA常发生于无高血糖的情况下，这使得诊断更具挑战性。由于这类药物对SGLT2的抑制作用是可逆的，停药后预计尿糖会迅速恢复。在本文中，我们报告了1例50岁2型糖尿病女性患者，在开始使用卡格列净治疗后发生了血糖正常的DKA。该例与SGLT2抑制剂使用相关的DKA具有独特性，因其表现为低血糖且持续性尿糖。SGLT2抑制剂如卡格列净不仅可能使患者易患糖尿病酮症酸中毒，还可能导致持续性尿糖。
