People with type 1 diabetes who are taking SGLT-2 inhibitors (Dapagliflozin, Empagliflozin, Canagliflozin and Ertugliflozin) are at risk of developing diabetic ketoacidosis during any illness. During the Coronavirus epidemic there are some additional safety considerations in treating DKA in patients with COVID-19. In the absence of high quality evidence to guide us, ABCD believes that clinicians may wish to discuss these medications with their patients and possibly mutually agree to stop SGLT-2 inhibitors and control blood glucose by adjusting insulin doses.
We recommend that people with type 1 diabetes should not be initiated on SGLT-2 inhibitors in addition to insulin until COVID epidemic is over.
People with type 2 diabetes can continue to take SGLT-2 inhibitor drugs unless they become unwell. If they become unwell for any reason, it is advisable to stop this class of drugs until complete recovery. People with type 2 diabetes who have had DKA once, should not restart these drugs
Full guidance on SGLT-2 inhibitors including sick day rule on page10,11
Further information for patients can be found at Diabetes UK
