Sodium-glucose cotransporter 2 inhibitor-induced postoperative euglycaemic diabetic ketoacidosis after pancreatectomy.

Abstract

Diabetes mellitus (DM) is present in up to 15 per cent of patients undergoing surgery1. This is likely an underestimate for patients undergoing pancreatectomy given that new-onset DM or impaired glucose intolerance occurs in up to 80 per cent of patients with pancreatic ductal adenocarcinoma (PDAC)2. Sodium–glucose cotransporter 2 inhibitors (SGLT2i) inhibit the reabsorption of glucose in the proximal tubule leading to glucosuria and are rapidly growing in popularity, with indications for the treatment of diabetes, heart failure, and kidney disease3. Euglycaemic diabetic ketoacidosis (euDKA) is a known complication associated with SGLT2i, with the US Food and Drug Administration (FDA) first releasing a warning about the adverse event in 20154,5. SGLT2i use in the setting of metabolic stress of surgery greatly increases the risk of SGLT2i-induced euDKA6. Multiple case reports have highlighted the risk of euDKA in the perioperative period7–9. However, little is known about the incidence of DKA in patients on SGLT2i post-partial pancreatectomy. The goals of this short report are to describe the experience with patients on SGLT2i in the perioperative period and to highlight the potential dangers of use of this drug class in pancreatectomy.