The Prevention of Diabetic Ketoacidosis in Patients with Type 2 Diabetes on Sodium-Glucose Transport Protein 2 Inhibitors

Abstract

Background: Sodium-Glucose Transport Protein 2 Inhibitors (SGLT2Is) effectively control diabetes. Diabetic ketoacidosis (DKA) has been reported as a life-threatening adverse effect due to SGLT2Is use. Aim: This study aims to review the current evidence of incidence, predisposing factors and the prevention of DKA in T2DM patients on SGLT2Is use. Methods and Materials: Two reviewers have conducted a search strategy of studies published in English between August 2012 and November 2020, in EBSCOhost, Google Scholar, PubMed, Science Direct and Wiley. Two reviewers independently assessed the eligibility and quality of the studies and extracted the data. Results: 85 studies were identified in the initial search; 75 records were removed and finally, 10 studies were included. Only studies discussing the prevention of DKA in T2DM patients on SGLT2Is were selected, extracted and categorized into main domains that included SGLT2Is use inT2DM patients and DKA (50%), SGLT2Is use in T2DM patients (20%), the clinical presentation of DKA (20%) and DKA prevention (10%). Six studies showed SGLT2Is increased the risk of DKA with very low rates in two studies. The precipitating factors of DKA in all included studies were revealed asstopping or reducing insulin, trauma, infection, surgery, severe acute illness, vigorous exercise, dehydration, low carbohydrate intake and excessive alcohol intake. In two studies DKA can be prevented by wakefulness and education, in one study by closed follow-up, in one study by regular monitoring and adjustment of medications and in two studies by recognition of patients at risk. Conclusions: This review summarized the prevention of DKA in T2DM patients on SGLT2Is use with consideration of incidence, a summary of evidence and predisposing factors. Physicians, health care providers and patients should be aware of SGLT2Is use, regular follow up, precipitating factors, symptoms, signs and prevention of DKA. Keywords: Sodium-Glucose Transport Protein 2 Inhibitors SGLT2Is, Type 2 diabetes mellitus, Diabetic Ketoacidosis, Scoping Review.