News in brief: Flash monitoring to guide DKA insulin infusion; Bariatric surgery’s mortality benefit; Revised guidance on SGLT2i and periprocedural DKA

Thursday, 29 Apr 2021

Flash monitoring to guide DKA insulin infusion

Flash glucose monitoring could potentially be used instead of capillary blood glucose measurements to drive insulin infusion rates in patients with diabetic ketoacidosis (DKA) in an acute inpatient setting, endocrinologists in South Australia have shown.

A comparison of hourly Flash glucose monitoring (FreeStyle Libre Sensor) with standard capillary blood glucose testing was carried out in ten patients with DKA managed at the Royal Adelaide Hospitals.

It found comparable glucose results and similar insulin infusion rates after allowing for a standard correction of 2mmol/L for Flash glucose monitoring, in patients in DKA.

“Based on our results, a trial of clinical outcomes in DKA patients treated with insulin infusion rates driven by [capillary blood glucose] vs subcutaneous FGM appears justified,” said the investigators led by Dr Lisa Bichard and Prof David Torphy.

The Flash glucose monitoring method of testing would potentially improve patient comfort, obviate fatigue, improve staff time and direct patient contact and potentially facilitate rapid discharge, they suggested.

More details: Endocrine Practice.

Bariatric surgery benefits on mortality

Bariatric surgery should be considered as a first-line treatment for people with severe obesity and diabetes because it produces substantial reductions in mortality and severe outcomes, Canadian investigators say.

In a retrospective cohort study of 3455 patients with type 2 diabetes and severe obesity (BMI >35) who underwent bariatric surgery, they observed a 47% hazard reduction in all-cause mortality, a 68% decrease in cardiovascular mortality, and a 34% decrease in composite cardiac events associated with bariatric surgery compared with a matched control group after almost five years of follow-up. Patients who underwent surgery also had a 42% decrease in nonfatal renal events.

Bariatric surgery was associated with an absolute reduction in mortality of 2.7% overall, with greater absolute reductions for men (3.7%), people with more than 15 years of diabetes (-4.3%) and people over 55 (-4.7%).

“This study reinforces that the glycaemic benefit of bariatric surgery found in randomised clinical trials likely translates to a mortality benefit over time,” the authors concluded in JAMA Network Open.

Revised criteria for SGLT2i and periprocedural DKA

Advice has been revised on when to cancel colonoscopy due to a risk of diabetic ketoacidosis (DKA) in T2D patients taking sodium–glucose cotransporter 2 inhibitor (SGLT2i) therapy.

A clinical alert update from the Australian Diabetes Society (ADS) in 2020 advised colonoscopy cancellation if capillary ketone concentrations were >1.0 mmol/L when SGLT2i had not been withheld for 72 hours. However, ketone cutoffs have now been revised upwards to 1.7 mmol/L in new guidelines based on a normal range calculated by Victorian clinicians for capillary ketone concentrations at the time of colonoscopy.  The new upper limit should help avoid unnecessary colonoscopy cancellation, according to Dr Peter Hamblin of Western Health, Melbourne.

More details in Diabetes Care.

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