Pancreatitis in a 57-Year-Old Female Two Weeks After Initiation of Empagliflozin

Abstract

Background/ObjectivePancreatitis is a common diagnosis requiring hospital admission, associated with significant costs. Although pancreatitis is an established side-effect with other diabetes medications, such as Glucagon like Peptide-1 Receptor Agonists and Dipeptidyl Peptidase 4 inhibitors, the association with SGLT2 inhibitors is not established. We present a patient with empagliflozin associated drug-induced acute pancreatitis (DIAP) and a review of published case reports. Case ReportA 57-year-old woman with T2DM presented to the hospital with severe abdominal pain. Her vital signs on presentation were temperature 98.3 F, blood pressure 139/79 mm Hg, pulse 62/min, and respiratory rate 15/min, saturating 99% on room air. Labs were notable for white blood cell count 12.8 (4.5-10.8 10∗3 μl), lipase- 36 (7-60 U/L), calcium- 9.4 (8.5-10.5 mg/dL), and triglycerides- 150 (35-150 mg/dL). Computed tomography abdomen showed induration of the peripancreatic fat, suggesting pancreatitis. No alcohol use was reported. DIAP and idiopathic pancreatitis were considered possible etiologies. Medication history revealed that the patient was started on empagliflozin 2 weeks before this admission. Empagliflozin was discontinued and she was discharged on metformin and glipizide. DiscussionSodium Glucose Transporter 2 inhibitors (SGLT2) inhibitors are increasingly used for treating type 2 diabetes mellitus and heart failure. The association of these medications with pancreatitis, its timeline, and the underlying mechanisms are yet to be understood. This case is intended to add to the existing limited literature on this side effect. ConclusionsWith the increasing use of SGLT2 inhibitors, more cases of DIAP are being reported. Physicians need to consider SGLT2 inhibitors as a possible cause of pancreatitis after excluding other etiologies.