Sodium-glucose cotransporter-2 (SGLT-2) inhibitors are a group of medications used to manage type 2 diabetes mellitus. These drugs work by preventing the reabsorption of glucose in the kidneys, leading to glucose excretion in the urine.
This mechanism has been shown to lower blood glucose levels and improve glycemic control. However, recently there has been concern about the link between SGLT-2 inhibitors and diabetic ketoacidosis (DKA).
What is Diabetic Ketoacidosis?
DKA is a life-threatening complication of diabetes characterized by high blood glucose, ketone production, and metabolic acidosis.
It usually occurs in individuals with type 1 diabetes, but can also occur in individuals with type 2 diabetes, particularly in those with insulin deficiency or insulin resistance. DKA presents with symptoms such as abdominal pain, nausea, vomiting, fruity breath, and altered mental status. Without prompt treatment, DKA can lead to coma and death.
How are SGLT-2 inhibitors linked to DKA?
The link between SGLT-2 inhibitors and DKA is thought to be due to their mechanism of action. By inhibiting glucose reabsorption in the kidneys, these drugs increase the excretion of glucose and water in the urine.
This leads to volume depletion and a shift in metabolism towards fat breakdown and ketone production. In individuals with underlying insulin deficiency or insulin resistance, this shift in metabolism can result in DKA.
SGLT-2 inhibitors have also been found to increase glucagon secretion and decrease insulin secretion, further exacerbating the risk of DKA in those already at risk.
These drugs have also been associated with other adverse effects such as urinary tract infections, genital infections, and hypoglycemia.
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Adverse Effects of SGLT-2 inhibitors
What are the risk factors for developing DKA with SGLT-2 inhibitors?
Not everyone who takes SGLT-2 inhibitors will develop DKA. However, certain factors increase the risk of DKA in those taking these drugs. These factors include:.
- Insulin deficiency or insulin resistance
- Low carbohydrate intake or fasting
- Alcohol consumption
- Dehydration
- Illness or infection
- Pregnancy
- Recent surgery
- Use of other medications such as corticosteroids or diuretics
How can DKA be prevented in those taking SGLT-2 inhibitors?
To minimize the risk of DKA in those taking SGLT-2 inhibitors, it is important to educate patients about the signs and symptoms of DKA and advise them to seek medical attention if these symptoms occur.
Patients should also be advised to monitor their blood glucose and ketone levels regularly, particularly during periods of illness, fasting, or reduced oral intake. It is also important to avoid SGLT-2 inhibitors in those with underlying risk factors for DKA, such as individuals with insulin deficiency or those who are fasting.
What should be done if DKA occurs in those taking SGLT-2 inhibitors?
If DKA occurs in an individual taking an SGLT-2 inhibitor, prompt treatment is required to avoid complications.
Treatment typically involves intravenous fluids to correct volume depletion, insulin to lower blood glucose levels and ketone production, and correction of any underlying factors such as infection or dehydration. In some cases, hospitalization may be required.
Conclusion
SGLT-2 inhibitors are a valuable option for the management of type 2 diabetes mellitus. However, their use is associated with an increased risk of DKA, particularly in those with underlying risk factors.
To minimize this risk, it is important to educate patients about the signs and symptoms of DKA, advise them to monitor their blood glucose and ketone levels regularly, and avoid the use of SGLT-2 inhibitors in those with underlying risk factors. In cases where DKA occurs, prompt treatment is required to avoid complications.
