Qiang Wei, Yang Fei, Liu Ling, Dong Ruiqing, Sun Yushi, Mondal Ahona, Guo Hui
Department of Endocrinology and Metabolism The First Affiliated Hospital of Xi'an Jiaotong University Xi'an P. R. China.
Department of Endocrinology The First Affiliated Hospital of Xi'an Medical University Xi'an P. R. China.
Clin Case Rep. 2024 Sep 11;12(9):e9282. doi: 10.1002/ccr3.9282. eCollection 2024 Sep.
High-dose acarbose may increase the risk of diabetic ketosis/diabetic ketoacidosis in Asian patients on sodium-glucose cotransporter-2 inhibitors. Healthcare providers and patients should be cautious to avoid this combination.
Low-calorie diets should be avoided in patients receiving sodium-glucose cotransporter-2 (SGLT-2) inhibitors to decrease the risk of diabetic ketoacidosis (DKA). High-dose acarbose can decelerate carbohydrate absorption. We detail three cases of diabetic ketosis (DK) following concurrent SGLT-2 inhibitor and high-dose acarbose therapy (acarbose 300 mg/day and dapagliflozin 10 mg/day). Patients, aged 38-63 years with 3-10 years of type 2 diabetes mellitus (T2DM), developed DK, indicated by moderate urinary ketones and high glucose (urine ketone 2+ to 3+ and glucose 3+ to 4+) without acidosis, within 4 days to 1 month post-therapy initiation. Serum glucose was 172.8-253.8 mg/dL; HbA1c was 9.97%-10.80%. The combination therapy was halted, and DK was managed with low-dose intravenous insulin and fluids, followed by intensive insulin therapy. High-dose acarbose with SGLT-2 inhibitors may increase the risk of DK/DKA in Asian patients.
对于正在使用钠-葡萄糖协同转运蛋白2抑制剂的亚洲患者，大剂量阿卡波糖可能会增加糖尿病酮症/糖尿病酮症酸中毒的风险。医疗服务提供者和患者应谨慎避免这种联合用药。
接受钠-葡萄糖协同转运蛋白2（SGLT-2）抑制剂治疗的患者应避免低热量饮食，以降低糖尿病酮症酸中毒（DKA）的风险。大剂量阿卡波糖可延缓碳水化合物吸收。我们详细介绍了3例在同时使用SGLT-2抑制剂和大剂量阿卡波糖治疗（阿卡波糖300毫克/天和达格列净10毫克/天）后发生糖尿病酮症（DK）的病例。38至63岁、患有2型糖尿病（T2DM）3至10年的患者，在开始治疗后4天至1个月内出现DK，表现为中度尿酮体和高血糖（尿酮体2+至3+，葡萄糖3+至4+），无酸中毒。血清葡萄糖为172.8至253.8毫克/分升；糖化血红蛋白为9.97%至10.80%。停止联合治疗，采用小剂量静脉胰岛素和补液治疗DK，随后进行强化胰岛素治疗。大剂量阿卡波糖与SGLT-2抑制剂联合使用可能会增加亚洲患者发生DK/DKA的风险。
