Euglycemic Diabetic Ketoacidosis With Sodium-Glucose Cotransporter-2 Inhibitor Use Post-Bariatric Surgery: A Brief Review of the Literature

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2020 Nov 12

PMID 33178530

Citations 6

Authors

Qasim Z Iqbal

Danil Mishiyev

Zeeshan Zia

Raffaele A Ruggiero

Ghulam Aftab

Affiliations

Soon will be listed here.

Abstract

Sodium-glucose cotransporter-2 (SGLT-2) inhibitors are antihyperglycemic drugs that are currently being recommended as second-line therapy for patients with diabetes mellitus. SGLT-2 Inhibitors function by inhibiting renal cotransporters, which reduces the reabsorption of glucose in the kidney, ultimately decreasing the concentration of glucose in the body. They have gained popularity in recent years due to their protective effects on the heart and kidneys - both organ systems that diabetes mellitus has shown to have a deleterious effect on. However, despite their growing fame, they have been found to increase the risk of euglycemic diabetic ketoacidosis (DKA). Euglycemic DKA is particularly dangerous as there is a chance that it can be missed by clinicians due to glucose levels generally being less than 200 mg/dL. There is an increasing body of literature detailing cases of euglycemic DKA after bariatric surgery. We present a brief review of the literature regarding this important side effect of SGLT-2 inhibitors seen in patients after bariatric surgery.

Citing Articles

A Case of Prolonged Recovery for Post-percutaneous Coronary Intervention (PCI) Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitor-Induced Euglycemic Diabetic Ketoacidosis in a 28-Year-Old.

Petersen C, Gyabaah F, Sotelo J, Yohanna S, Deoker A Cureus. 2023; 15(9):e45180.

PMID: 37842482 PMC: 10575758. DOI: 10.7759/cureus.45180.

Euglycemic diabetic ketoacidosis in the era of SGLT-2 inhibitors.

Chow E, Clement S, Garg R BMJ Open Diabetes Res Care. 2023; 11(5).

PMID: 37797963 PMC: 10551972. DOI: 10.1136/bmjdrc-2023-003666.

Potential Clinical Applications for Continuous Ketone Monitoring in the Hospitalized Patient with Diabetes.

Jaromy M, Miller J Curr Diab Rep. 2022; 22(10):501-510.

PMID: 35984565 PMC: 9388986. DOI: 10.1007/s11892-022-01489-6.

Risk of Harm from Use of Sodium-Glucose Co-Transporter-2 (SGLT-2) Inhibitors in Patients Pre or Post Bariatric Surgery.

Sharma M, Nayar R, Graham Y, Parretti H, Abbott S, Tahrani A Obes Surg. 2022; 32(7):2469-2470.

PMID: 35482224 DOI: 10.1007/s11695-022-06044-6.

New Diabetic Medication Sodium-Glucose Cotransporter-2 Inhibitors Can Induce Euglycemic Ketoacidosis and Mimic Surgical Diseases: A Case Report and Review of Literature.

Kietaibl A, Fasching P, Glaser K, Petter-Puchner A Front Surg. 2022; 9:828649.

PMID: 35402477 PMC: 8987984. DOI: 10.3389/fsurg.2022.828649.

References

Lane S, Paskar D, Hamed S, Goffi A . When Guidelines Fail: Euglycemic Diabetic Ketoacidosis After Bariatric Surgery in a Patient Taking a Sodium-Glucose Cotransporter-2 Inhibitor: A Case Report. A A Pract. 2018; 11(2):46-48. DOI: 10.1213/XAA.0000000000000734. View

Bolinder J, Ljunggren O, Kullberg J, Johansson L, Wilding J, Langkilde A . Effects of dapagliflozin on body weight, total fat mass, and regional adipose tissue distribution in patients with type 2 diabetes mellitus with inadequate glycemic control on metformin. J Clin Endocrinol Metab. 2012; 97(3):1020-31. DOI: 10.1210/jc.2011-2260. View

Qaseem A, Barry M, Humphrey L, Forciea M, Fitterman N, Horwitch C . Oral Pharmacologic Treatment of Type 2 Diabetes Mellitus: A Clinical Practice Guideline Update From the American College of Physicians. Ann Intern Med. 2017; 166(4):279-290. DOI: 10.7326/M16-1860. View

Aminian A, Kashyap S, Burguera B, Punchai S, Sharma G, Froylich D . Incidence and Clinical Features of Diabetic Ketoacidosis After Bariatric and Metabolic Surgery. Diabetes Care. 2016; 39(4):e50-3. PMC: 8176207. DOI: 10.2337/dc15-2647. View

Perkovic V, Jardine M, Neal B, Bompoint S, Heerspink H, Charytan D . Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy. N Engl J Med. 2019; 380(24):2295-2306. DOI: 10.1056/NEJMoa1811744. View

Andalib A, ElBahrawy A, AlShlwi S, Alkhamis A, Hu W, Demyttenaere S . Diabetic Ketoacidosis Following Bariatric Surgery in Patients With Type 2 Diabetes. Diabetes Care. 2016; 39(8):e121-2. DOI: 10.2337/dc16-0280. View

Goldenberg R, Berard L, Cheng A, Gilbert J, Verma S, Woo V . SGLT2 Inhibitor-associated Diabetic Ketoacidosis: Clinical Review and Recommendations for Prevention and Diagnosis. Clin Ther. 2016; 38(12):2654-2664.e1. DOI: 10.1016/j.clinthera.2016.11.002. View

Koliaki C, Liatis S, le Roux C, Kokkinos A . The role of bariatric surgery to treat diabetes: current challenges and perspectives. BMC Endocr Disord. 2017; 17(1):50. PMC: 5553790. DOI: 10.1186/s12902-017-0202-6. View

Handelsman Y, Henry R, Bloomgarden Z, Dagogo-Jack S, DeFronzo R, Einhorn D . AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY POSITION STATEMENT ON THE ASSOCIATION OF SGLT-2 INHIBITORS AND DIABETIC KETOACIDOSIS. Endocr Pract. 2016; 22(6):753-62. DOI: 10.4158/EP161292.PS. View

10.

Mulla C, Baloch H, Hafida S . Management of Diabetes in Patients Undergoing Bariatric Surgery. Curr Diab Rep. 2019; 19(11):112. DOI: 10.1007/s11892-019-1242-2. View

11.

Dowsett J, Humphreys R, Krones R . Normal Blood Glucose and High Blood Ketones in a Critically Unwell Patient with T1DM Post-Bariatric Surgery: a Case of Euglycemic Diabetic Ketoacidosis. Obes Surg. 2018; 29(1):347-349. DOI: 10.1007/s11695-018-3548-6. View

12.

Wiviott S, Raz I, Bonaca M, Mosenzon O, Kato E, Cahn A . Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2018; 380(4):347-357. DOI: 10.1056/NEJMoa1812389. View

13.

Neal B, Perkovic V, Mahaffey K, de Zeeuw D, Fulcher G, Erondu N . Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. N Engl J Med. 2017; 377(7):644-657. DOI: 10.1056/NEJMoa1611925. View

14.

Marx N, Grant P, Cosentino F . Compelling evidence for SGLT2 inhibitors and GLP-1 receptor agonists as first-line therapy in patients with diabetes at very high/high cardiovascular risk. Eur Heart J. 2019; 41(2):329-330. DOI: 10.1093/eurheartj/ehz853. View

15.

Sajja A, Dey A, Guha A, Elnabawi Y, Joshi A, Kalra A . SGLT-2 Inhibitors and GLP-1 Agonists: First-Line Therapy for Diabetes With Established Cardiovascular Disease. J Cardiovasc Pharmacol Ther. 2019; 24(5):422-427. DOI: 10.1177/1074248419838511. View

16.

Modi A, Agrawal A, Morgan F . Euglycemic Diabetic Ketoacidosis: A Review. Curr Diabetes Rev. 2016; 13(3):315-321. DOI: 10.2174/1573399812666160421121307. View

17.

Lau A, Bruce S, Wang E, Ree R, Rondi K, Chau A . Perioperative implications of sodium-glucose cotransporter-2 inhibitors: a case series of euglycemic diabetic ketoacidosis in three patients after cardiac surgery. Can J Anaesth. 2017; 65(2):188-193. DOI: 10.1007/s12630-017-1018-6. View

18.

Ogawa W, Sakaguchi K . Euglycemic diabetic ketoacidosis induced by SGLT2 inhibitors: possible mechanism and contributing factors. J Diabetes Investig. 2016; 7(2):135-8. PMC: 4773669. DOI: 10.1111/jdi.12401. View

19.

Isom K, Andromalos L, Ariagno M, Hartman K, Mogensen K, Stephanides K . Nutrition and metabolic support recommendations for the bariatric patient. Nutr Clin Pract. 2014; 29(6):718-39. DOI: 10.1177/0884533614552850. View

20.

Arterburn D, Olsen M, Smith V, Livingston E, Van Scoyoc L, Yancy Jr W . Association between bariatric surgery and long-term survival. JAMA. 2015; 313(1):62-70. DOI: 10.1001/jama.2014.16968. View