Juneja D, Nasa P, Jain R, Singh O. Sodium-glucose Cotransporter-2 Inhibitors induced euglycemic diabetic ketoacidosis: A meta summary of case reports. World J Diabetes 2023; 14(8): 1314-1322 [PMID: 37664476 DOI: 10.4239/wjd.v14.i8.1314]
Corresponding Author of This Article
Deven Juneja, FCCP, MD, Director, Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, 1, Press Enclave Road, New Delhi 110017, India. devenjuneja@gmail.com
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Diabetes. Aug 15, 2023; 14(8): 1314-1322 Published online Aug 15, 2023. doi: 10.4239/wjd.v14.i8.1314
Sodium-glucose Cotransporter-2 Inhibitors induced euglycemic diabetic ketoacidosis: A meta summary of case reports
Deven Juneja, Prashant Nasa, Ravi Jain, Omender Singh
Deven Juneja, Omender Singh, Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi 110017, India
Prashant Nasa, Department of Critical Care Medicine, NMC Specialty Hospital, Dubai 7832, United Arab Emirates
Prashant Nasa, Department of Internal Medicine, College of Medicine and Health Sciences, Al Ain 15551, Abu Dhabi, United Arab Emirates
Ravi Jain, Department of Critical Care Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur 302022, Rajasthan, India
Author contributions: Juneja D acquisition of data, analysis and interpretation of data, drafting the article, final approval; Nasa P acquisition of data, analysis and interpretation of data, drafting the article, final approval; Jain R interpretation of data, revising the article, final approval; Singh O designing the study, drafting the article, final approval.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Deven Juneja, FCCP, MD, Director, Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, 1, Press Enclave Road, New Delhi 110017, India. devenjuneja@gmail.com
Received: April 27, 2023 Peer-review started: April 27, 2023 First decision: May 19, 2023 Revised: May 20, 2023 Accepted: June 19, 2023 Article in press: June 19, 2023 Published online: August 15, 2023
ARTICLE HIGHLIGHTS
Research background
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are commonly prescribed drugs in managing patients with diabetes mellitus (DM). These agents may rarely lead to the development of euglycemic diabetic ketoacidosis (EDKA), which may complicate the disease course of these patients.
Research motivation
EDKA is a rare, but mostly missed and under-reported complication of DM management. The use of SGLT2i may increase the risk of developing EDKA.
Research objectives
The main aim of this meta-summary was to identify the predisposing factors, symptomatology, clinical course and outcomes of the patients on SGLT2i presenting with EDKA.
Research methods
We performed a systematic search of PubMed, Science Direct, Google Scholar and Reference Citation Analysis (https://www.referencecitationanalysis.com/) databases using the terms “canagliflozin” OR “empagliflozin” OR “dapagliflozin” OR “SGLT2 inhibitors” OR “Sodium-glucose cotransporter-2” AND “euglycemia” OR “euglycemic diabetic ketoacidosis” OR “metabolic acidosis”.
Research results
Overall, 108 case reports and 17 cases series with 169 unique patients were included. One hundred and forty-nine (88.2%) patients had underlying type II diabetes, and the most commonly involved SGLT2 inhibitor reported was empagliflozin (46.8%). A triggering factor was reported in most patients (78.7%), the commonest being acute severe infection (37.9%). Sixty-one-point-five percent were reported to require intensive unit care, but only a minority of patients required organ support. The overall mortality rate was only 2.4%.
Research conclusions
Patients on SGLT2i may rarely develop EDKA, especially in the presence of certain predisposing factors. The signs and symptoms of EDKA may be similar to those of DKA but with normal blood sugar levels. Outcomes of EDKA are good if recognized early and corrective actions are taken.
Research perspectives
Large scale studies must be conducted to find out the true incidence and clinical impact of EDKA in patients using SGLT2i.
