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SGLT-2 inhibitors up risk of diabetic ketoacidosis

06 Aug 2020

Sodium–glucose cotransporter-2 (SGLT-2) inhibitors increase the risk for diabetic ketoacidosis (DKA) by almost threefold, with molecule-specific analyses suggesting a class effect, according to a study.

DKA was diagnosed in 521 patients during 370,454 person-years of follow-up (incidence rate per 1,000 person-years, 1.40, 95 percent confidence interval [CI], 1.29–1.53).

SGLT-2 inhibitors correlated with an increased risk for DKA when compared with dipeptidyl peptidase-4 (DPP-4) inhibitors (incidence rate, 2.03, 95 percent CI, 1.83–2.25 vs 0.75, 95 percent CI, 0.63–0.89; hazard ratio [HR], 2.85, 95 percent CI, 1.99–4.08). Molecule-specific HRs were 1.86 (95 percent CI, 1.11–3.10) for dapagliflozin, 2.52 (95 percent CI, 1.23–5.14) for empagliflozin, and 3.58 (95 percent CI, 2.13–6.03) for canagliflozin.

Such association was not modified by age and sex, but prior receipt of insulin appeared to lower the risk.

This population-based cohort study utilized electronic healthcare databases from seven Canadian provinces and the UK.  Using time-conditional propensity scores, a total of 208,757 new users of SGLT-2 inhibitors were matched 1:1 to users of DPP-4 inhibitors.

The investigators used Cox proportional hazards models to estimate site-specific HRs of DKA, comparing receipt of SGLT-2 inhibitors with that of DPP-4 inhibitors. Random effects models were used to pool results. Secondary analyses were stratified by age, sex, molecule, and prior insulin use.

The study was limited by unmeasured confounding and lack of available laboratory data for the majority of patients. In addition, molecule-specific analyses were carried out at a limited number of sites.

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Most Read Articles
30 Aug 2020
Diabetes bears an increased hazard of developing kidney cancer among postmenopausal women, but this association is only limited to those without obesity, a study has shown.
11 Jul 2020
Individuals who eat large amounts of vegetables and fruits, wheat, nuts, and dairy products are better protected against insulin resistance, diabetes mellitus, and excessive abdominal fat as compared with those who consume lots of fast foods, alcoholic beverages, and desserts—a dietary pattern described to promote metabolic abnormalities and disorders, as reported in a study.
22 Aug 2020
A weakened correlation between fructosamine and glycated haemoglobin (HbA1c) levels may be indicative of obesity in type 2 diabetes patients, reports a new study.
29 Aug 2020
Sodium-glucose co-transporters (SGLT) 2 and 1/2 inhibitors help improve glycaemic control in patients with type 1 diabetes (T1D), reports a new meta-analysis.