AI Article Synopsis

  • Sodium glucose cotransporter inhibitors like sotagliflozin can raise beta-hydroxybutyrate (BHB) levels in people with type 1 diabetes who require insulin, leading to potential risks of diabetic ketoacidosis (DKA).
  • In a study comparing sotagliflozin 400 mg to a placebo over 6 months, median BHB levels increased slightly, with about 67% of patients experiencing no significant change.
  • Key factors affecting BHB levels and DKA risk included baseline BHB, age, and use of insulin pumps, emphasizing the need for careful monitoring and personalized education about DKA management.

Article Abstract

Sodium glucose cotransporter inhibitors may increase beta-hydroxybutyrate (BHB) in insulin-requiring patients. We determined factors associated with BHB changes from baseline (ΔBHB) and diabetic ketoacidosis (DKA) in patients with type 1 diabetes (T1D) receiving sotagliflozin as an insulin adjunct. This post hoc analysis compared ΔBHB levels in adults with T1D receiving sotagliflozin 400 mg or placebo for 6 months. We evaluated clinical and metabolic factors associated with ΔBHB and used logistic regression models to determine predictors associated with BHB values >0.6 and >1.5 mmol/L (inTandem3 population;  = 1402) or with DKA events in a pooled analysis (inTandem1-3;  = 2453). From baseline (median, 0.13 mmol/L), median fasting BHB increased by 0.04 mmol/L (95% confidence interval, 0.03-0.05;  < 0.001) at 24 weeks with sotagliflozin versus placebo; 67% of patients had no or minimal changes in BHB over time. Factors associated with on-treatment BHB >0.6 or >1.5 mmol/L included baseline BHB and sotagliflozin use. Age, insulin pump use, sotagliflozin use, baseline BHB, and ΔBHB were significantly associated with DKA episodes. Independent of treatment, DKA risk increased by 18% with each 0.1-mmol/L increase in baseline BHB and by 8% with each 0.1-mmol/L increase from baseline. Incremental increases in baseline BHB and ΔBHB were associated with a higher DKA risk independent of treatment. Adding sotagliflozin to insulin increased median BHB over 24 weeks in patients with T1D and was associated with increased DKA events. These results highlight the importance of BHB testing and monitoring and individualizing patient education on DKA risk, mitigation, identification, and treatment.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11535465PMC
http://dx.doi.org/10.1089/dia.2023.0605DOI Listing

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