Recent analysis suggests that while SGLT2 inhibitors remain vital in managing type 2 diabetes, certain patients face a heightened risk of life-threatening diabetic ketoacidosis, prompting calls for closer monitoring.
A new review of evidence suggests that sodium-glucose co-transporter 2, or SGLT2, inhibitors, a widely used class of type 2 diabetes medicines, can raise the risk of diabetic ketoacidosis in some patients, particularly soon after treatment starts. The warning comes from a report summarising a recent analysis of roughly 280,000 people with type 2 diabetes and is reinforced by earlier cohort studies and meta-analyses showing that risk is not evenly spread across all patients. The condition can become life-threatening if it is not recognised and treated quickly.
Researchers say the danger is highest in people with a previous episode of diabetic ketoacidosis, poor blood sugar control, low bicarbonate levels, kidney problems or other markers of frailty before treatment begins. A large US cohort study published in the National Center for Biotechnology Information found that prior diabetic ketoacidosis, baseline haemoglobin A1c, creatinine, bicarbonate levels and some other pre-treatment characteristics helped predict hospitalisation for diabetic ketoacidosis among people starting SGLT2 inhibitors.
Other studies point in the same direction, even if the size of the effect varies. A systematic review and network meta-analysis published on PubMed found no clear difference in diabetic ketoacidosis risk between SGLT2 inhibitors, other diabetes drugs and placebo, but said the overall certainty of the evidence was low to moderate and that canagliflozin may carry a higher risk than some other drugs in the class. A separate meta-analysis also reported a higher risk versus placebo or comparator medicines, while an Australian multicentre cohort study found higher odds of diabetic ketoacidosis among SGLT2 users than non-users.
Doctors are being urged to watch for warning signs such as intense thirst, frequent urination, stomach pain and nausea, and to treat suspected diabetic ketoacidosis as an emergency. Infection was the most common trigger reported in the recent review. Even so, the researchers stressed that the benefits of SGLT2 inhibitors remain important, and they were not calling for the drugs to be stopped routinely, but for clinicians to identify which patients may need closer monitoring.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
