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Diabetes Metab. 2019 Jan 9. pii: S1262-3636(19)30001-1. doi: 10.1016/j.diabet.2019.01.001. [Epub ahead of print]

Clinical characteristics of diabetic ketoacidosis in users and non-users of SGLT2 inhibitors.

Author information

1
Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Republic of Korea.
2
Department of Internal Medicine, CHA Bundang Medical Centre, CHA University, Seongnam, Republic of Korea.
3
Division of Endocrinology and Metabolism, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea.
4
Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea.
5
Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Hospital Bucheon, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea.
6
Department of Internal Medicine, Gwangmyeong Sungae Hospital, Gwangmyeong, Republic of Korea.
7
Division of Endocrinology and Metabolism, Department of Internal medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea.
8
Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Ansan, Republic of Korea.
9
Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea.
10
Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Republic of Korea. Electronic address: djkim@ajou.ac.kr.

Abstract

AIM:

This study investigated the clinical characteristics of diabetic ketoacidosis (DKA) and compared the DKA characteristics between patients treated with and without SGLT2 inhibitors.

METHODS:

Data were collected from patients aged ≥ 18 years admitted for DKA at nine centres in Korea between September 2014 and April 2017. The electronic medical records of these subjects were retrospectively reviewed. Based on their history of medications taken before admission, subjects were classified as either users or non-users of SGLT2 inhibitors and their clinical characteristics of DKA were compared.

RESULTS:

During the study, the main subtype of DKA episodes (n = 523) was identified as type 2 diabetes (51%). Average hospitalization duration was 11 days, and average intensive care unit (ICU) time was 2.5 days. The in-hospital mortality rate was 3%, but no users of SGLT2 inhibitors died during DKA treatment. In patients taking SGLT2 inhibitors (n = 15), DKA manifested at 124 days, on average, after starting the inhibitors (range: 7-380 days). Also, SGLT2 inhibitors users had significantly lower plasma glucose levels (413 mg/dL) compared with non-users (554 mg/dL), and longer ICU stays (4 vs. 2 days; P = 0.019).

CONCLUSION:

In this report of recent data on the clinical features of DKA in Korea, patients using SGLT2 inhibitors needed longer treatment in ICUs compared with non-users and had lower levels of blood glucose, whereas DKA associated with SGLT2 inhibitors was rare.

KEYWORDS:

Diabetic ketoacidosis; Republic of Korea; Sodium–glucose cotransporter-2 inhibitors

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