Department of Medicine, Queen's University, Kingston, Ontario, Canada.
School of Nursing, Queen's University, Kingston, Ontario, Canada.
Can J Diabetes. 2021 Apr;45(3):214-219. doi: 10.1016/j.jcjd.2020.08.100. Epub 2020 Aug 21.
In this study, we examined the prevalence and clinical characteristics of sodium-glucose cotransporter-2 inhibitor (SGLT2i)-associated diabetes ketoacidosis (DKA).
A retrospective chart review of patients admitted for DKA over 4 years. Patients with SGLT2i-associated DKA were invited for pancreatic autoantibody testing. A subset of patients were invited for an interview to identify clinical characteristics suggestive of undiagnosed latent autoimmune diabetes in adults (LADA).
Of 647 DKA admissions, 6.6% were associated with SGLT2i use. Time from SGLT2i initiation and DKA ranged from 2 weeks to 3.25 years; 69.8% had euglycemic DKA. Pancreatic autoantibody testing on 20 patients identified 5 originally diagnosed with type 2 as having LADA. Four were interviewed and had a LADA clinical risk score predictive of this diagnosis.
A larger study is needed to qualify the role of the LADA clinical risk score with confirmatory pancreatic autoantibody testing before SGLT2i initiation to reduce DKA risk.
本研究旨在探讨钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2i）相关糖尿病酮症酸中毒（DKA）的患病率和临床特征。
对 4 年来因 DKA 住院的患者进行回顾性病历审查。邀请 SGLT2i 相关 DKA 患者进行胰腺自身抗体检测。邀请部分患者进行访谈，以确定提示成人隐匿性自身免疫性糖尿病（LADA）的未确诊的临床特征。
在 647 例 DKA 住院患者中，有 6.6%与 SGLT2i 有关。从 SGLT2i 开始使用到 DKA 的时间为 2 周至 3.25 年；69.8%为血糖正常的 DKA。对 20 名患者进行胰腺自身抗体检测，发现 5 名最初诊断为 2 型糖尿病的患者患有 LADA。对其中 4 名患者进行了访谈，他们的 LADA 临床风险评分提示了这一诊断。
需要进行更大规模的研究，在开始使用 SGLT2i 之前，通过确认胰腺自身抗体检测来确定 LADA 临床风险评分的作用，以降低 DKA 风险。
