Department of Physiology and Pharmacology, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden.
Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, 171 76, Stockholm, Sweden.
Crit Care. 2023 May 16;27(1):189. doi: 10.1186/s13054-023-04481-y.
Sodium glucose co-transporter-2 (SGLT2) inhibitors improve long-term cardiovascular and renal outcomes in individuals with type 2 diabetes. However, the safety of SGLT2 inhibitors in ICU patients with type 2 diabetes is uncertain. We aimed to perform a pilot study to assess the relationship between empagliflozin therapy and biochemical, and clinical outcomes in such patients.
We included 18 ICU patients with type 2 diabetes receiving empagliflozin (10 mg daily) and insulin to target glucose range of 10-14 mmol/l according to our liberal glucose control protocol for patients with diabetes (treatment group). Treatment group patients were matched on age, glycated hemoglobin A1c, and ICU duration with 72 ICU patients with type 2 diabetes exposed to the same target glucose range but who did not receive empagliflozin (control group). We compared changes in electrolyte and acid-base parameters, hypoglycemia, ketoacidosis, worsening kidney function, urine culture findings, and hospital mortality between the groups.
Median (IQR) maximum increase in sodium and chloride levels were 3 (1-10) mmol/l and 3 (2-8) mmol/l in the control group and 9 (3-12) mmol/l and 8 (3-10) mmol/l in the treatment group (P = 0.045 for sodium, P = 0.059 for chloride). We observed no differences in strong ion difference, pH or base excess. Overall, 6% developed hypoglycemia in each group. No patient in the treatment group and one patient in the control group developed ketoacidosis. Worsening kidney function occurred in 18% and 29% of treatment and control group patients, respectively (P = 0.54). Urine cultures were positive in 22% of treatment group patients and 13% of control group patients (P = 0.28). Overall, 17% of treatment group patients and 19% of control group patients died in hospital (P = 0.79).
In our pilot study of ICU patients with type 2 diabetes, empagliflozin therapy was associated with increases in sodium and chloride levels but was not significantly associated with acid-base changes, hypoglycemia, ketoacidosis, worsening kidney function, bacteriuria, or mortality.
钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂可改善 2 型糖尿病患者的长期心血管和肾脏结局。然而，SGLT2 抑制剂在 2 型糖尿病 ICU 患者中的安全性尚不确定。我们旨在进行一项初步研究，以评估依帕列净治疗与这类患者的生化和临床结局之间的关系。
我们纳入了 18 例接受依帕列净（每日 10mg）治疗的 ICU 2 型糖尿病患者，并根据我们针对糖尿病患者的宽松血糖控制方案（治疗组）将胰岛素靶标血糖范围设定为 10-14mmol/L。治疗组患者按年龄、糖化血红蛋白 A1c 和 ICU 持续时间与 72 例接受相同靶标血糖范围但未接受依帕列净治疗的 2 型糖尿病 ICU 患者（对照组）相匹配。我们比较了两组间电解质和酸碱参数、低血糖、酮症酸中毒、肾功能恶化、尿培养结果和住院死亡率的变化。
对照组和治疗组中钠和氯水平的最大增加值中位数（IQR）分别为 3（1-10）mmol/L 和 3（2-8）mmol/L，9（3-12）mmol/L 和 8（3-10）mmol/L（P=0.045 用于钠，P=0.059 用于氯）。我们未观察到强离子差、pH 值或碱剩余的差异。总体而言，两组各有 6%的患者发生低血糖。治疗组无患者、对照组有 1 例患者发生酮症酸中毒。治疗组和对照组肾功能恶化的患者分别占 18%和 29%（P=0.54）。治疗组患者的尿培养阳性率为 22%，对照组为 13%（P=0.28）。总体而言，治疗组患者中有 17%、对照组中有 19%的患者在住院期间死亡（P=0.79）。
在我们的 2 型糖尿病 ICU 患者初步研究中，依帕列净治疗与钠和氯水平升高相关，但与酸碱变化、低血糖、酮症酸中毒、肾功能恶化、菌尿症或死亡率无显著相关性。
