Aims
SGLT2-inhibitors are associated with DKA with lower-than-expected glycaemia in patients with diabetes. Consequently, neither hyperglycaemia nor ketonuria can be reliably used in the diagnosis of DKA in these patients (1). The obsolescence of these parameters to guide clinicians presents a diagnostic challenge. The recently published JBDS and the older AACE/ACE guidelines both provide for euglycaemia and the use of capillary ketones as a diagnostic criterion for DKA (2,3). The other criteria used include: HC03 >15mmol/L, anion gap >10 and pH <7.3. This retrospective study compared diagnostic criteria employed to diagnose DKA across two centres.
Methods
All patients (165) with T2DM presenting with DKA between 2015 – 2022 were identified from the electronic medical record and divided into those currently receiving SGLT2i at time of diagnosis and those who were not (no-SGLT2i). Clinical characteristics, biochemical parameters and thresholds used to make the diagnosis of DKA were recorded. Statistical analysis was performed.
Results
Significantly fewer cases in the SGLT2i group met criteria for DKA compared to the non-SGLT2i group according to both AACE/ACE (56% vs 72%, p = 0.035) and JBDS guidelines (63% vs 82% p = 0.009). Diagnostic cut-offs and biochemical parameters between groups varied ([pH <7.3 67% vs 96%, p = 0.036], [HC03 <15mmol 43% vs 74%, p = 0.000]) pH (7.23 vs 7.17, p = 0.006), HbA1c (9.33% vs 11.6%, p = 0.000). Differences in the use of statins (32.6% vs 39.7%, p = 0.001) and Metformin (89% vs 63%, p = 0.000) was observed. There was no significant difference in capillary ketone level between groups.
Conclusion
A history of SGLT2i use may result in the over-diagnosis of diabetic ketoacidosis in patients with type 2 diabetes