PSUN190 Is Euglycemic Diabetic Ketoacidosis an Underrecognized Risk of SGLT2 Inhibitor Utilization?

Abstract

Abstract Introduction Sodium-glucose cotransporter-2 (SGLT2) inhibitors were first approved by the FDA in March of 2013 as a promising new medication in the treatment of Type II diabetes mellitus. The mechanism of action of the Sodium-glucose cotransporter-2 is in the convoluted tubule of the nephron and where it inhibits the reabsorption of glucose into the bloodstream. The utilization has increased with promising improvements in congestive heart failure and renal protection. However, as the use of these medications has risen, so have the concerns over their side effects, specifically the frequency of euglycemic diabetic ketoacidosis (euDKA). Initial trials reported an incidence of DKA among patients taking an SGLT2 inhibitor to be between 0.003% and 0.34%. Hypothesis As a quality initiative, we reviewed internal data at a large hospital system to evaluate the rate of euDKA. We hypothesized that the rate of euDKA from SGLT2 was higher than reported. Methods To test this hypothesis, a 5 year retrospective internal quality review was conducted to quantify the number of patients admitted to our institution with DKA while on an SGLT2 inhibitor medication. We used the Epic Database from 4 hospitals in our system and applied the application "Slicer Dicer". We used keywords for diabetic ketoacidosis. We then reviewed the medication lists prior to admission and upon admission for the 4 commercially available SGLT2 agents: empagliflozin, canagliflozin, dapagliflozin. Results 1748 patients were identified with DKA from 2018-2021 were reviewed. Of this population, 164 of them were on SGLT2 medications. The data identified 9.4% of total patients admitted for DKA in our hospital system were taking SGLT2 medications on presentation. Out of this population: 41.5% were on empagliflozin, 27.4% were on canagliflozin, 29.3% were on dapagliflozin, and 1.8% were on ertugliflozin. Out of these same patients, 51.8% were taking a high dosage of SGLT2i medication, whereas 48.2% were taking a low dosage. Conclusion/Discussion This data supports the hypothesis that the incidence of SGLT2 induced euDKA is underreported. There was no correlation between DKA and the use of high versus low dosage of SGLT2i medications. Since DKA is a problem related to dehydration, future educational initiatives should emphasize the importance of educating providers on when to hold medications to prevent DKA. This should include how to plan for sick days and educating patients on the risks presented by their medication. We recommend that ICD codes are updated to include euglycemic DKA and side effects of SGLT2. We believe that these simple changes can reduce the incidence of euDKA in the diabetic population as the indications for therapy expand in vulnerable populations. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.