Lyu Young Sang
Department of Endocrinology and Metabolism, Chosun University Hospital, School of Medicine, Chosun University, Gwangju 61452, Republic of Korea.
Healthcare (Basel). 2025 Sep 8;13(17):2245. doi: 10.3390/healthcare13172245.
Sodium-glucose cotransporter-2 (SGLT2) inhibitors are widely used to manage type 2 diabetes mellitus (T2DM) because of their glucose-lowering and cardioprotective effects. However, euglycemic diabetic ketoacidosis (euDKA) is an uncommon but serious adverse event. EuDKA is characterized by metabolic acidosis and ketosis with only mild-to-moderate hyperglycemia, making diagnosis challenging. The risk of this interaction may be increased with the concurrent use of glucagon-like peptide-1 receptor agonists (GLP-1RAs), particularly during periods of reduced caloric intake or the presence of gastrointestinal symptoms. A 38-year-old woman with newly diagnosed T2DM presented with five days of fatigue, poor oral intake, nausea, and vomiting. She had recently initiated semaglutide (GLP-1RA) for weight loss and practiced prolonged intermittent fasting. One week prior, she had started metformin and enavogliflozin, a selective SGLT2 inhibitor. Laboratory results showed a glucose level of 137 mg/dL, urine ketones (+++), lactate level of 4.87 mg/dL, HbA1c of 9.3%, C-peptide of 0.88 ng/mL, and high anion gap metabolic acidosis. She was diagnosed with euDKA and treated with IV fluids, insulin infusion, dextrose, and potassium supplementation. Her symptoms resolved, and she was discharged in a stable condition. This case highlights the importance of recognizing euDKA in patients using SGLT2 inhibitors and GLP-1RAs, particularly those with fasting or gastrointestinal symptoms. Clinicians should suspect euDKA even without significant hyperglycemia to enable prompt diagnosis and management, thereby preventing complications.
钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂因其降血糖和心脏保护作用而被广泛用于治疗2型糖尿病（T2DM）。然而，正常血糖性糖尿病酮症酸中毒（euDKA）是一种罕见但严重的不良事件。euDKA的特征是代谢性酸中毒和酮症，仅伴有轻度至中度高血糖，这使得诊断具有挑战性。同时使用胰高血糖素样肽-1受体激动剂（GLP-1RAs）可能会增加这种相互作用的风险，尤其是在热量摄入减少或出现胃肠道症状期间。一名新诊断为T2DM的38岁女性出现了五天的疲劳、食欲不振、恶心和呕吐。她最近开始使用司美格鲁肽（GLP-1RA）减肥，并进行了长时间的间歇性禁食。一周前，她开始服用二甲双胍和选择性SGLT2抑制剂恩格列净。实验室结果显示血糖水平为137mg/dL，尿酮（+++），乳酸水平为4.87mg/dL，糖化血红蛋白为9.3%，C肽为0.88ng/mL，以及高阴离子间隙代谢性酸中毒。她被诊断为euDKA，并接受了静脉输液、胰岛素输注、葡萄糖和补钾治疗。她的症状得到缓解，出院时情况稳定。 该病例强调了在使用SGLT2抑制剂和GLP-1RAs的患者中识别euDKA的重要性，尤其是那些有禁食或胃肠道症状的患者。即使没有明显的高血糖，临床医生也应怀疑euDKA，以便能够及时诊断和处理，从而预防并发症。
