Department of Pharmacy, First Affiliated Hospital of Naval Military Medical University, Shanghai, China.
Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China.
Clin Ther. 2023 Jul;45(7):e167-e170. doi: 10.1016/j.clinthera.2023.05.006. Epub 2023 May 27.
Euglycemic diabetic ketoacidosis (euDKA) is a rare but life-threatening adverse effect of sodium-glucose cotransporter 2 (SGLT2) inhibitors. We present a case of delayed euDKA seven days after cure of acute pancreatitis and discharge from the hospital of a 51-year-old man with type 2 diabetes mellitus (T2DM) managed with a combination of antidiabetic medications, including the SGLT2 inhibitor dapagliflozin. Prior acute pancreatitis was postulated to be a contributing factor to the development of SGLT2 inhibitor-associated euDKA in this patient discharged from the hospital. The patient was managed accordingly and improved clinically while his oral hypoglycemic agents were stopped. The risk of euDKA from SGLT2 inhibitor therapy may be increased by some stress factors (eg, infection, surgery, acute illness, low-carbohydrate diet, excessive alcohol intake). As these SGLT2 inhibitors become a popular therapeutic strategy for the management of hyperglycemia in T2DM, clinicians should be aware that acute illnesses such as pancreatitis in patients with T2DM can be potential predisposing factors for the development of SGLT2 inhibitor-associated euDKA.
血糖正常的糖尿病酮症酸中毒（euDKA）是钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂的一种罕见但危及生命的不良反应。我们报告了一例 51 岁 2 型糖尿病（T2DM）男性患者的病例，他在急性胰腺炎治愈并出院后七天出现 euDKA，该患者接受了包括 SGLT2 抑制剂达格列净在内的多种降糖药物治疗。推测该患者出院后患有的急性胰腺炎是导致 SGLT2 抑制剂相关 euDKA 的一个促成因素。患者接受了相应的治疗，在停用口服降糖药后临床状况得到改善。SGLT2 抑制剂治疗引起的 euDKA 风险可能会因某些应激因素（如感染、手术、急性疾病、低碳水化合物饮食、过度饮酒）而增加。随着这些 SGLT2 抑制剂成为治疗 T2DM 高血糖的一种流行治疗策略，临床医生应注意到，T2DM 患者的急性疾病（如胰腺炎）可能是发生 SGLT2 抑制剂相关 euDKA 的潜在诱发因素。
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