Patients with type 2 diabetes treated with SGLT2 inhibitors are more likely to receive a diabetic ketoacidosis diagnosis than those not taking the glucose-lowering medication despite not meeting international criteria, a study suggests.
Australian researchers say their findings have implications for patients who might be unnecessarily missing out on the “important” class of drugs.
The retrospective observational study involved 164 adult patients with type 2 diabetes from two teaching hospitals in Queensland who were diagnosed with diabetic ketoacidosis (DKA) between 2015 and 2022.
At the time of diagnosis, 94 patients were taking SGLT2 inhibitors (45% female, mean age 63) and 70 were not on the medication (53% female, mean age 62).
For “true” diagnoses of DKA, the researchers relied on the published Joint British Diabetes Society (JBDS) and American Association of Clinical Endocrinology/American College of Endocrinology (AACE/ACE) criteria, which they said had been recently updated to account for the physiological effects of SGTL2 inhibitors.
Findings published in the Journal of Diabetes Research [link here] revealed a significantly smaller proportion of patients in the SGLT2i cohort met JBDS (56% vs 72%) and AACE/ ACE (63% vs 82%) criteria compared to non-SGLT2i patients.
However, both groups had a large number of patients who did not fall under the DKA criteria, noted the researchers from Gold Coast Health and Griffith University.
Euglycaemia was observed in 39% and 48%, respectively, of patients in the SGLT2i group versus 3% in the non-SGLT2i group based on JBDS (<11 mmol/L) and AACE/ACE/American Diabetes Association (<13.9 mmol/L) criteria.
Other findings showed significant differences in pH, serum bicarbonate, and eGFR between the SGLT2i and non-SGLT2i groups. Significant differences were also observed in blood glucose levels (median 14.35 mmol/L vs 26.25 mmol/L).