Sodium-glucose Cotransporter-2 Inhibitors induced euglycemic diabetic ketoacidosis: A meta summary of case reports

Table 1 Baseline patient parameters

Parameter	Number of patients, n = 169
Age (± SD), yr	51.7 (13.8)
Gender, n (%)	Females, 92 (54.4)
	Males, 77 (45.6)
Type of diabetes, n (%)	Type I, 18 (10.7)
	Type II, 149 (88.2)
	Not mentioned, 2 (1.1)
Body mass index (± SD)	29.6 (6.4)
Clinical presentation, n (%)	Nausea/Vomiting, 110 (65.1)
	Abdominal pain, 63 (37.3)
	Breathlessness, 52 (30.8)
	Fatigue, 46 (27.2)
	Altered mental status, 34 (20.1)
	Loss of consciousness, 11 (6.5)
	Chest pain, 5 (3)
	Shock, 4 (2.4)
	Fever, 4 (2.4)
	Others, 12 (7.1)
Comorbidities, n (%)	Diabetes, 166 (98.2)
	Hypertension, 45 (26.6)
	Coronary artery disease, 20 (11.8)
	Dyslipidemia, 13 (7.7)
	Cancer, 4 (2.4)
	Others, 24 (14.4)
SGLT-2 inhibitor involved, n (%)	Empagliflozin, 79 (46.8)
	Canagliflozin, 50 (29.6)
	Dapagliflozin, 39 (23.1)
	Ipragliflozin, 1 (0.6)
	Tofogliflozin, 1 (0.6)
Other OHAs prescribed, n (%)	Yes, 135 (79.9)
	No, 25 (14.8)
	Not mentioned, 9 (5.1)
Other diabetes medications involved, n (%)	Metformin, 119 (70.4)
	Dipeptidyl peptidase 4 inhibitors, 42 (24.9)
	Sulfonylureas, 26 (15.4)
	Thiazolidinediones, 10 (5.9)
	Meglitinides, 3 (1.8)
	α-Glucosidase inhibitors, 2 (1.2)
	Insulins, 57 (33.7)
	Glucagon-like peptide-1 receptor agonist, 21 (12.4)
	Not mentioned, 11 (6.5)
History of alcohol use, n (%)	6 (3.6)
Identifiable triggering factor, n (%)	Present, 133 (78.7)
Triggering factor, n (%)	Infection, 64 (37.9)
	Major surgery, 41 (24.3)
	Reduced food intake, 32 (18.9)
	Any major illness, 17 (10.1)
	Reduced carbohydrate/ketogenic diet 14 (8.3)
	Dehydration, 14 (8.3)
	Reduced insulin dosages, 10 (5.9)
	Prolonged fasting, 9 (5.3)
	Trauma, 2 (1.2)
Ketones for diagnosis, n (%)	Only urine, 62 (36.7)
	Only plasma, 36 (21.3)
	Both, 60 (35.5)
	Not mentioned, 11 (6.5)
Organ failure, n (%)	Respiratory, 20 (11.8)
	Cardiac, 11 (6.5)
	Renal, 8 (4.7)
Need for organ support, n (%)	Invasive mechanical ventilation, 22 (13)
	Vasopressors, 11 (6.5)
	RRT, 10 (5.9)
Other treatments given, n (%)	Sodium bicarbonate, 21 (12.4)
Need for ICU, n (%)	104 (61.5)
Days in ICU (± SD)	3.4 (5.4) d
Days in hospital (± SD)	9.3 (10.4) d
Outcome, n (%)	Alive, 164 (97)
	Death, 4 (2.4)
	Not mentioned, 1 (0.6)

SGLT: Sodium-glucose-cotransporter; OHA: Oral hypoglycemic agent; RRT: Renal replacement therapy; IMV: Invasive mechanical ventilation; ICU: Intensive care unit.

Table 2 Baseline laboratory parameters

Parameter	Median values
Blood glucose (IQR)	184.5 (151.8-219.3) mg/dL
Serum osmolality (IQR)	297 (290.8-312.8) mmol/kg
pH (IQR)	7.14 (7.05-7.24)
Bicarbonate (IQR)	8.6 (6-11) mmol/L
Lactates (IQR)	1.3 (1.1-1.8) mmol/L
Anion gap (IQR)	22.50 (19-28) mmol/L

IQR: Interquartile range.