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Poster 22: A series of diabetic ketoacidosis associated with the use of sodium-glucose co-transporter-2 inhibitors in secondary care

Sofia Taverner1, David M Williams2, Cindy Eng1, Rebecca Watson1, Siba George2, Amanda Edwards2, Jeffrey W Stephens2,3

1Department of Acute Medicine, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK;

2Department of Diabetes & Endocrinology, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK;

3Diabetes Research Group, Swansea Unive

Background and aims: Sodium-glucose co-transporter-2 inhibitors (SGLT-2i) are associated with diabetic ketoacidosis (DKA), though limited real-world case series are published. The aim of this study is to examine the number and characteristics of patients admitted with SGLT2i-associated DKA to our hospital over a 4-month period.

Methods: Patients were retrospectively identified following referral to the diabetes team with SGLT2i-associated DKA between September-December 2021. Medical notes were reviewed and data related to the patients’ characteristics, diabetes control, usual medications and previous medical comorbidities were collected.

Results: Twenty-two patients with SGLT2i-associated DKA were identified; 21 (95.5%) were hyperglycaemic and 1 (4.5%) was euglycaemic. Patients had a mean age (±standard deviation) 60.8±12.3 years and HbA1c 89.2±29.2 mmol/mol (10.3%). Most patients (45.5%) were diagnosed with DKA alone, though some had concurrent bacterial (27.3%) or COVID-19 (18.2%) infection. There was significant treatment heterogeneity, with 9 (40.9%) patients treated with insulin and 13 (59.1%) patients with other agents. Thirteen (59.1%) patients had no significant medical comorbidity, though 9 (40.9%) patients had underlying cardiovascular, respiratory and/or malignant comorbidity. Of the 22 patients admitted with DKA, 19 (86.4%) were discharged alive, and 3 (13.6%) died during the admission.

Conclusion: We observed no specific characteristics which pre-disposed to SGLT2i-associated DKA or more severe ketoacidosis in this cohort, consistent with previous studies. Most cases were in hyperglycaemic DKA, and people with SGLT2i-associated euglycaemic DKA may have been missed. Given the number of cases observed in our hospital and the associated mortality, greater awareness of the condition is essential.

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