895-P: Effect of Long-Term Empagliflozin Therapy on Plasma Beta-Hydroxy Butyrate (ß-OHB)—Lack of Effect of Concomitant Insulin, GLP-1 Agonist, or Pioglitazone Therapy

Abstract

Sodium-glucose transporter 2 (SGLT2) inhibitors are associated with increased risk of euglycemic diabetic ketoacidosis in T2DM. Possible mechanisms include increased lipolysis, elevated glucagon, and decreased plasma insulin levels. Therefore, concomitant high dose insulin as well as thiazolidinediones could potentially attenuate the rise in β-OHB because of anti-lipolytic effects. However, this has not been examined in the real-world clinical studies. We examined the effect of long-term Empagliflozin therapy on plasma β-OHB in veterans with T2DM. A retrospective chart review was performed in 43 subjects who had fasting β-OHB, C-peptide and detailed anthropometric measurements and were followed for 23 ± 2.5 months. Subjects were categorized into two groups based on fasting β-OHB concentrations (< or ≥2.8mg/dl). Eleven patients (24.4%) had high (6.03 ±1.22mg/dl) while 32 (74.6%) had normal β-OHB (1.42±0.09 mg/dL). There was no difference in age (59 ± 4 vs 62 ±2 yrs), BMI (35±1 vs 32 ±1 kg/m2), or the duration of diabetes (15 ± 3 vs 18±2 yrs) between the two groups. Subjects with higher β-OHB had higher HbA1c (8.9 ±0.7 vs 7.9 ± 0.3%, p<0.05). There was no difference in fasting C-peptide (3.2 ± 0.9 vs 3.5 ± 0.5ng/ml), total daily insulin dose (184± 43 vs 214±19 units/day), number of subjects on Pioglitazone (54 vs 35%) or GLP-1 agonist therapy (36 vs 52%) between the two groups. In conclusion, long-term therapy with Empagliflozin leads to elevated β-OHB in 25% of T2DM and it was associated with poor glycemic control. Concomitant insulin or pioglitazone therapy did not alter plasma β-OHB concentration. Disclosure L.C.Ortiz: None. J.Wortham: None. S.Pinkson: None. J.Trejo: None. A.S.Mendoza: None. X.Chen: None. D.Tripathy: None.