Hamblin Peter S, Wong Rosemary, Ekinci Elif I, Sztal-Mazer Shoshana, Balachandran Shananthan, Frydman Aviva, Hanrahan Timothy P, Hu Raymond, Ket Shara N, Moss Alan, Ng Mark, Ragunathan Sashikala, Bach Leon A
Department of Endocrinology and Diabetes, Western Health, Melbourne, Victoria, Australia.
Department of Medicine, Western Health, The University of Melbourne, Melbourne, Victoria, Australia.
Clin Endocrinol (Oxf). 2022 Apr;96(4):549-557. doi: 10.1111/cen.14621. Epub 2021 Oct 26.
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been associated with diabetic ketoacidosis at the time of colonoscopy. This study aimed to identify factors associated with ketone concentrations in SGLT2i-treated type 2 diabetes compared with non-SGLT2i-treated diabetes, and those with impaired fasting glycaemia (IFG) and normoglycaemia.
Cross-sectional, multicentre, observational study June-December 2020 in four Australian tertiary hospitals.
Capillary glucose and ketones were measured in people undergoing colonoscopy: 37 SGLT2i-treated and 105 non-SGLT2i-treated type 2 diabetes, 65 IFG and 151 normoglycaemia.
Body mass index (BMI), age, glucose, fasting duration and where relevant, HbA1c and time since last SGLT2i dose.
In SGLT2i-treated diabetes, BMI (ρ = -0.43 [95% confidence interval: -0.67, -0.11]) and duration since last SGLT2i dose (ρ = -0.33 [-0.60, 0.00]) correlated negatively with increasing ketones, but there was no correlation with fasting duration. In non-SGLT2i-treated diabetes, BMI correlated negatively (ρ = -0.24 [-0.42, -0.05]) and fasting duration positively (ρ = 0.26 [0.07, 0.43]) with ketones. In IFG participants, only fasting duration correlated with ketones (ρ = 0.28 [0.03, 0.49]). In normoglycaemic participants, there were negative correlations with BMI (ρ = -0.20 [-0.35, -0.04]) and fasting glucose (ρ = -0.31 [-0.45, -0.15]) and positive correlations with fasting duration (ρ = 0.20 [0.04, 0.35]) and age (ρ = 0.19 [0.03, 0.34]). Multiple regression analysis of the entire cohort showed BMI, age and fasting glucose remained independently associated with ketones, but in SGLT2i-treated participants only BMI remained independently associated.
In SGLT2i-treated diabetes, lower BMI was a novel risk factor for higher ketones precolonoscopy. Pending larger confirmatory studies, extra vigilance for ketoacidosis is warranted in these people.
钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）与结肠镜检查时的糖尿病酮症酸中毒有关。本研究旨在确定与接受SGLT2i治疗的2型糖尿病患者相比，未接受SGLT2i治疗的糖尿病患者、空腹血糖受损（IFG）患者和血糖正常者酮浓度相关的因素。
2020年6月至12月在澳大利亚四家三级医院进行的横断面、多中心观察性研究。
对接受结肠镜检查的患者测量毛细血管血糖和酮水平：37例接受SGLT2i治疗的2型糖尿病患者、105例未接受SGLT2i治疗的2型糖尿病患者、65例IFG患者和151例血糖正常者。
体重指数（BMI）、年龄、血糖、禁食时长，以及相关情况下的糖化血红蛋白（HbA1c）和距上次服用SGLT2i的时间。
在接受SGLT2i治疗的糖尿病患者中，BMI（ρ = -0.43 [95%置信区间：-0.67，-0.11]）和距上次服用SGLT2i的时长（ρ = -0.33 [-0.60，0.00]）与酮水平升高呈负相关，但与禁食时长无关。在未接受SGLT2i治疗的糖尿病患者中，BMI与酮水平呈负相关（ρ = -0.24 [-0.42，-0.05]），禁食时长与酮水平呈正相关（ρ = 0.26 [0.07，0.43]）。在IFG参与者中，仅禁食时长与酮水平相关（ρ = 0.28 [0.03，0.49]）。在血糖正常的参与者中，BMI（ρ = -0.20 [-0.35，-0.04]）和空腹血糖（ρ = -0.31 [-0.45，-0.15]）与酮水平呈负相关，禁食时长（ρ = 0.20 [0.04，0.35]）和年龄（ρ = 0.19 [0.03，0.34]）与酮水平呈正相关。对整个队列进行的多元回归分析显示，BMI、年龄和空腹血糖仍与酮水平独立相关，但在接受SGLT2i治疗的参与者中，只有BMI仍与酮水平独立相关。
在接受SGLT2i治疗的糖尿病患者中，较低的BMI是结肠镜检查前酮水平升高的一个新的危险因素。在有更多确证性研究之前，这些人群有必要对酮症酸中毒格外警惕。
