Vitale Rebecca J, Valtis Yannis K, McDonnell Marie E, Palermo Nadine E, Fisher Naomi D L
Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Department of Medicine, Brigham and Women's Hospital, Medical Residency Office, Boston, Massachusetts.
AACE Clin Case Rep. 2021 Jan-Feb;7(1):10-13. doi: 10.1016/j.aace.2020.11.019. Epub 2020 Dec 28.
Diabetes mellitus is associated with poor outcomes in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Diabetic ketoacidosis (DKA) has also been reported to occur with this virus. A cluster of cases of euglycemic DKA (euDKA) was identified in patients with type 2 diabetes mellitus using sodium-glucose cotransporter-2 inhibitors (SGLT2is) who developed SARS-CoV-2 infection.
The cases were identified by the authors while providing clinical care, and details were collected.
Five cases of euDKA, presenting with glucose levels <300 mg/dL, were identified over the course of 2 months by the endocrinology consult service. All patients had a history of type 2 diabetes mellitus with no known history of DKA. All were taking SGLT2is. Oral antihyperglycemic medications were stopped for all patients on admission. All received intravenous insulin infusion to treat DKA before being transitioned to a subcutaneous insulin regimen. SGLT2i use was discontinued for all patients who were discharged.
EuDKA has been seen in the setting of acute illness in patients using SGLT2is, but this cluster of cases suggests that there is a specific association with SARS-CoV-2 infection. In addition to the known risk of euDKA with SGLT2i use, coronavirus disease 2019-specific mechanisms may include a direct toxic effect of the virus on the pancreatic islets, an accelerated inflammatory response promoting ketosis, and the diuretic effect of SGLT2i in conjunction with anorexia and vomiting. It is crucial to counsel patients to stop SGLT2is when sick, especially if SARS-CoV-2 infection is suspected.
糖尿病与严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染的不良预后相关。据报道，该病毒感染还会引发糖尿病酮症酸中毒（DKA）。在使用钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）且感染SARS-CoV-2的2型糖尿病患者中，发现了一组正常血糖性DKA（euDKA）病例。
作者在提供临床护理时识别出这些病例，并收集了详细信息。
内分泌会诊服务在2个月内共识别出5例euDKA病例，其血糖水平<300mg/dL。所有患者均有2型糖尿病病史，无已知DKA病史。所有患者均在服用SGLT2i。入院时所有患者均停用口服降糖药。所有患者在转为皮下胰岛素治疗方案之前均接受静脉胰岛素输注以治疗DKA。所有出院患者均停用SGLT2i。
在使用SGLT2i的患者急性疾病情况下可见euDKA，但这组病例表明其与SARS-CoV-2感染存在特定关联。除了使用SGLT2i已知的euDKA风险外，2019冠状病毒病的特定机制可能包括病毒对胰岛的直接毒性作用、促进酮症的加速炎症反应，以及SGLT2i与厌食和呕吐相关的利尿作用。建议患者在生病时，尤其是怀疑感染SARS-CoV-2时停用SGLT2i，这一点至关重要。
