Division of Endocrinology and Metabolism, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Diabetes Metab J. 2024 Nov;48(6):1169-1175. doi: 10.4093/dmj.2024.0036. Epub 2024 Jun 10.
One of the notable adverse effects of sodium-glucose cotransporter 2 (SGLT2) inhibitor is diabetic ketoacidosis (DKA) often characterized by euglycemia. In this retrospective review of patients with DKA from 2015 to 2023, 21 cases of SGLT2 inhibitorassociated DKA were identified. Twelve (57.1%) exhibited euglycemic DKA (euDKA) while nine (42.9%) had hyperglycemic DKA (hyDKA). More than 90% of these cases were patients with type 2 diabetes mellitus. Despite similar age, sex, body mass index, and diabetes duration, individuals with hyDKA showed poorer glycemic control and lower C-peptide levels compared with euDKA. Renal impairment and acidosis were worse in the hyDKA group, requiring hemodialysis in two patients. Approximately one-half of hyDKA patients had concurrent hyperosmolar hyperglycemic state. Common symptoms included nausea, vomiting, general weakness, and dyspnea. Seizure was the initial manifestation of DKA in two cases. Infection and volume depletion were major contributors, while carbohydrate restriction and inadequate insulin treatment also contributed to SGLT2 inhibitor-associated DKA. Despite their beneficial effects, clinicians should be vigilant for SGLT2 inhibitor risk associated with DKA.
钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂的一个显著不良反应是糖尿病酮症酸中毒（DKA），其特征通常为血糖正常。在对 2015 年至 2023 年期间的 DKA 患者进行的回顾性研究中，发现了 21 例 SGLT2 抑制剂相关的 DKA。其中 12 例（57.1%）表现为血糖正常的 DKA（euDKA），9 例（42.9%）表现为高血糖的 DKA（hyDKA）。这些病例中超过 90%的患者为 2 型糖尿病患者。尽管年龄、性别、体重指数和糖尿病病程相似，但与 euDKA 相比，hyDKA 个体的血糖控制较差，C 肽水平较低。hyDKA 组的肾功能不全和酸中毒更为严重，有 2 名患者需要进行血液透析。大约一半的 hyDKA 患者同时存在高渗性高血糖状态。常见症状包括恶心、呕吐、全身无力和呼吸困难。癫痫发作是 2 例 DKA 的首发症状。感染和容量不足是主要诱因，而碳水化合物限制和胰岛素治疗不足也与 SGLT2 抑制剂相关的 DKA 有关。尽管 SGLT2 抑制剂具有有益作用，但临床医生应警惕其与 DKA 相关的风险。
