Published online Aug 15, 2023. doi: 10.4239/wjd.v14.i8.1314
Peer-review started: April 27, 2023
First decision: May 19, 2023
Revised: May 20, 2023
Accepted: June 19, 2023
Article in press: June 19, 2023
Published online: August 15, 2023
Processing time: 105 Days and 17.1 Hours
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are commonly prescribed drugs in managing patients with diabetes mellitus (DM). These agents may rarely lead to the development of euglycemic diabetic ketoacidosis (EDKA), which may complicate the disease course of these patients.
EDKA is a rare, but mostly missed and under-reported complication of DM management. The use of SGLT2i may increase the risk of developing EDKA.
The main aim of this meta-summary was to identify the predisposing factors, symptomatology, clinical course and outcomes of the patients on SGLT2i presenting with EDKA.
We performed a systematic search of PubMed, Science Direct, Google Scholar and Reference Citation Analysis (https://www.referencecitationanalysis.com/) databases using the terms “canagliflozin” OR “empagliflozin” OR “dapagliflozin” OR “SGLT2 inhibitors” OR “Sodium-glucose cotransporter-2” AND “euglycemia” OR “euglycemic diabetic ketoacidosis” OR “metabolic acidosis”.
Overall, 108 case reports and 17 cases series with 169 unique patients were included. One hundred and forty-nine (88.2%) patients had underlying type II diabetes, and the most commonly involved SGLT2 inhibitor reported was empagliflozin (46.8%). A triggering factor was reported in most patients (78.7%), the commonest being acute severe infection (37.9%). Sixty-one-point-five percent were reported to require intensive unit care, but only a minority of patients required organ support. The overall mortality rate was only 2.4%.
Patients on SGLT2i may rarely develop EDKA, especially in the presence of certain predisposing factors. The signs and symptoms of EDKA may be similar to those of DKA but with normal blood sugar levels. Outcomes of EDKA are good if recognized early and corrective actions are taken.
Large scale studies must be conducted to find out the true incidence and clinical impact of EDKA in patients using SGLT2i.