AI Article Synopsis
- This study explored the risk of diabetic ketoacidosis (DKA) in insulin-treated type 1 diabetes patients taking SGLT2 inhibitors in a real-world setting.
- A cohort of 11,475 patients was analyzed, revealing that 16.5% were on SGLT2 inhibitors, with a DKA occurrence of 7.3% and a notably higher DKA rate compared to those not using the inhibitors.
- The findings indicate that SGLT2 inhibitors can increase the risk of DKA regardless of patient demographics, particularly during the first month of treatment, signaling a need for caution from both patients and healthcare providers.
Article Abstract
Aims/introduction: This study aimed to investigate the risk of diabetic ketoacidosis (DKA) in insulin-treated type 1 diabetes patients administered sodium-glucose cotransporter 2 (SGLT2) inhibitors in real-world clinical practice.
Materials And Methods: We carried out a real-world, retrospective, observational cohort study using Japanese Medical Data Vision, a diagnosis procedure combination database. We identified insulin-treated adult type 1 diabetes patients enrolled from December 2018 to October 2019. We assessed the incidence and risk of DKA in type 1 diabetes patients using SGLT2 inhibitors in an 'on-label' manner. Cox multivariate regression analyses were carried out to determine clinical factors linked to SGLT2 inhibitor-associated DKA.
Results: Of 11,475 type 1 diabetes patients, 1,898 (16.5%) were prescribed SGLT2 inhibitors. DKA occurred in 139 (7.3%) of these patients, with 20.2 incidences per 100 person-years. These patients also showed significantly higher DKA rates than did those not receiving SGLT2 inhibitors (hazard ratio 1.66, 95% confidence interval 1.33-2.06; P < 0.001). The mean time until DKA onset in SGLT2 inhibitor-treated type 1 diabetes patients was 30.6 ± 30.1 days. The risk of SGLT2 inhibitor-associated DKA increased in type 1 diabetes patients irrespective of sex, age or body mass index. However, the risk did not increase in type 1 diabetes patients receiving continuous subcutaneous insulin infusion, which warrants further investigation because of the small number of type 1 diabetes patients receiving continuous subcutaneous insulin infusion.
Conclusions: 'On-label' SGLT2 inhibitor use might increase DKA risk among insulin-treated type 1 diabetes patients irrespective of sex, age or body mass index. Both type 1 diabetes patients and healthcare providers should be wary of DKA, especially during the first month of initiating SGLT2 inhibitors.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8409873 | PMC |
| http://dx.doi.org/10.1111/jdi.13506 | DOI Listing |
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