Predisposing factors for the development of diabetic ketoacidosis with lower than anticipated glucose levels in type 2 d
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REVIEW
Predisposing factors for the development of diabetic ketoacidosis with lower than anticipated glucose levels in type 2 diabetes patients on SGLT2-inhibitors: a review Adeboye Olakunle Bamgboye 1
&
Isaac Oluwadamilare Oni 2 & Andrew Collier 3,4
Received: 17 June 2020 / Accepted: 20 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose SGLT2-inhibitors (SGLT-2i) have been linked to the risk of potential life-threatening diabetic ketoacidosis (DKA). The U.S. Food and Drug Administration and the European Medicines Agency issued warnings in 2015 and 2016 respectively on the predisposing factors to the development of DKA in individuals on an SGLT2i. New predisposing factors to DKA are still being discovered with the use of SGLT-2i. The list by FDA and EMA is yet to be updated. This article aims to provide a holistic list that includes the newer factors that have been implicated in the development of DKA. The overall aim is to guide physicians in prescribing this class of drugs for type 2 diabetes mellitus (T2D). Method A search was done using PUBMED, Google Scholar, and Directory of Open Access Journals with the following words: SGLT-2 Inhibitors AND Ketoacidosis were entered. We included articles from 2000 to 2020, those in English, those involving any of the approved SGLT2i medications in T2D patients, and studies that focused on DKA linked to SGLT-2i. These articles were reviewed, and relevant data extracted and compiled. Results and conclusion The review has revealed that predisposing factors include (excess) alcohol consumption, female gender, starvation due to illness or fasting, withholding the use of SGLT2i for less than 48 h peri-operatively, and the existence of a variations in the expression of SGLT2 receptors. Patients should be advised on “sick day rules,” and if a patient becomes unwell while on an SGLT2i, they should be advised to withhold the medication for the duration of the intercurrent illness. Keywords Euglycemic diabetic ketoacidosis . SGLT2-inhibitors . Predisposing . Type 2 diabetes
Introduction The incidence of type 2 diabetes mellitus (T2D) is steadily on the rise. T2D is no longer a disease for the adult population alone but is now seen, observed, and managed in children and adolescents [1]. Globally, the number of people with T2D has quadrupled in the past three decades and it is now the ninth major cause of death. The epidemic of T2D and its * Adeboye Olakunle Bamgboye [email protected] 1
Department of Pharmacology, Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Nigeria
2
Department of Pharmacognosy, Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Nigeria
3
Glasgow Caledonian University, Glasgow, UK
4
University Hospital Ayr, Ayr, UK
complications pose a major global health threat. The reasons for the escalating epidemic of diabetes mellitus are multiple, including population aging, economic development, urbanization, unhealthy eating habits, and sedentary lifestyles [2]. Over 90% of diabetes mellitus cases a
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