Diabetic ketoacidosis without hyperglycemia as a complication of SGLT2 inhibitors treatment

Abstract

SGLT2 inhibitors (gliflozins) are a new group of hypoglycemicdrugs which have been available on the marketfor the past four years. They inhibit the reabsorptionof glucose in the proximal renal tubules, reducethe renal glucose threshold and increase glycosuria,thereby lowering blood glucose levels. Clinical recommendationsof the Polish Diabetes Association mentionthe possibility of using gliflozins both as monotherapyin patients with type 2 diabetes, as well as in combinationwith other hypoglycemic drugs, including insulin.Databases of adverse events of SGLT2 inhibitors indicatean increased risk of diabetic ketoacidosis withoutsignificant hyperglycemia. An unusual course of thisform of acidosis makes the complication difficult todiagnose. This paper describes a possible pathogenicprocess of ketoacidosis without hyperglycemia. Thefact that this complication was observed mainly inpatients with prolonged type 2 diabetes (including patientstreated with insulin) and in patients with type 1diabetes who used the drug “off-label”, implies thatinsulin deficiency may be a pathogenic factor in thisdisorder. Another important factor was insufficientcarbohydrate intake associated with reduced foodconsumption due to illness or accompanying disorders.At the same time, in most cases, a decrease in insulindose stemming from low blood glucose levels wasobserved. The study highlighted the precautions andprevention methods for ketoacidosis without hyperglycemiain patients treated with SGLT2 inhibitors, aswell as proper and rapid diagnosis of this complication.