PSUN263 Diagnosis of Latent Autoimmune Diabetes of Adulthood Unveiled After Initiation of an SGLT2 Inhibitor

Abstract

Abstract SGLT2-inhibitors have revolutionized treatment for Type II diabetes (T2DM) due to their numerous benefits including improved glycemic control, cardioprotective properties, reduction of high blood pressure, and mitigation of disease progression in CKD.ew studies have investigated the benefits of this medication class on patients with Type 1 DM (T1DM). Herein we describe a case in which the diagnosis of latent autoimmune diabetes of adulthood (LADA) was unmasked following the use of an SGLT2-inhibitor. A 56-year-old female with a history of T2DM diagnosed 10 years ago presented to the endocrine clinic for management of her poorly controlled diabetes. Her medications then included insulin detemir, insulin lispro, metformin, and repaglinide, but she still had an HbA1c of 11.3% (n<5.7%). She was tried on glipizide early in her disease course but it was discontinued due to fluid retention. She had a sedentary lifestyle with a BMI of 31.27 kg/m2. She was requiring increased doses of insulin over time with minimal improvement in her HbA1c. Two years later she was started on liraglutide with increasing dosages. Her HbA1c continued to decrease down to 8.7% and her BMI had decreased to 26.83 kg/m2. Over the next year, her HbA1c began to again increase up to 9.8%. At this time canagliflozin was added to her medication regimen. She responded very well to this medication initially with a drop in her HbA1c to 7.5% and a decrease in her BMI to 24.01 kg/m2. Unfortunately, one year after initiation of the SGLT2-inhibitor she was hospitalized for DKA and pancreatitis. At this time all her medications, except for insulin and metformin, were discontinued. A GAD65 antibody (>250 IU/mL; n<5.0 IU/mL) and c-peptide (<0.1 ng/mL; n = 1.1-4.4 ng/mL) levels were checked at this time which revealed the diagnosis of LADA approximately 16 years after her initial diagnosis of T2DM. She was transitioned to an insulin pump and managed according to protocol. SGLT2 inhibitors have been studied as an adjuvant treatment with insulin for T1DM due to their ability to increase urinary glucose excretion but are currently not approved for T1DM. Despite their recorded benefits, they have also been shown to significantly increase the risk of DKA when used in patients with T1DM. Our patient, who was mistakenly treated as T2DM for almost two decades, was diagnosed with LADA after initiation of an SGLT2 inhibitor led to hospitalization for DKA. Further research is needed to assess the safety of SGLT2 inhibitors in T1DM, and caution must be taken when prescribing this medication to patients who may have underlying LADA. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.