891-P: SGLT2 Inhibitors Use and Diabetic Ketoacidosis in the Inpatient Setting

Abstract

Background: Current guidelines recommend SGLT2 inhibitors in patients with cardiovascular disease, chronic kidney disease and/or heart failure. Studies have demonstrated early initiation of SGLT2i in stable hospitalized patients to be safe and associated with benefits such as reduced hospitalization. However, SGLT2i are known to lower the threshold for developing diabetic ketoacidosis (DKA) and reported rates with real world use are higher than those seen in randomized controlled trials. There are limited studies evaluating the safe use of SGLT2i in the real world inpatient setting. Aim: The primary aim of this study is to determine the incidence of DKA in patients with diabetes admitted to hospital and started or continued on an SGLT2i. A secondary aim is to determine risk factors to inpatient SGLT2i associated acidosis and make recommendations for safe initiation in hospital. Methods: A retrospective chart review was performed on patients with diabetes admitted to a tertiary hospital with anion-gap metabolic acidosis (AGMA) between January 2020-June 2020 (prior to SGLTi being available on hospital formulary) compared to between January 2021-June 2021 (post-formulary). Patients were included if they were started or continued on an SGLT2i during their admission or were on an SGLT2i < 72h prior to admission. Results: 159 patient charts met our inclusion criteria, with 43.4% (n=69) admitted prior to SGLT2i being available on hospital formulary and 56.6% (n=90) admitted post-formulary. There was a 12.2% (n=11) increase in patients with AGMA with SGLT2i being available on hospital formulary. 41.0% of patients were above the age of 70, and common issues during admission were infection (66.7%), acute kidney injury (44.0%), surgery (23.3%), and/or confusion (23.9%). Conclusion: Increased use of SGLT2i in hospital resulted in an increase in incidence of inpatient DKA in older patients admitted with infection, AKI, surgery and/or confusion. Disclosure S.Zankar: None. A.Arnaout: None.