THU376 Isotretinoin Related DKA In Type 2 Diabetes

Abstract

Abstract Disclosure: N. Radovanovic: None. R.J. Comi: None. A. Crawford: None. Introduction: Isotretinoin is a well-established treatment for acne, known to have a wide variety of adverse effects including hypertriglyceridemia, decreased HDL, and, as per some reports, increased insulin resistance. Rapid worsening of underlying diabetes after treatment with isotretinoin has been described in the literature in patients with type 1 diabetes. Clinical Case: A 45-year-old man was referred to the Endocrinology clinic in February 2022 for an urgent consultation due to rapidly worsening hyperglycemia, acidosis, hypertriglyceridemia and refusal to be evaluated in ED as recommended by his PCP. He was diagnosed with pre-diabetes in April 2021 with an HgbA1c of 6.4% and instructed to make lifestyle changes. He presented 6 months later with HgbA1c of 7.3% and the diagnosis of diabetes prompted him to initiate earlier proposed lifestyle changes. He joined an online weight loss program and was very pleased to achieve a rapid weight loss of 80 lbs within 4 months. Upon initial telephone consultation with the patient, he reported feeling well and refused our recommendations to go to the ED, but agreed to come to our clinic the next day. Upon initial in-person assessment, he denied nausea, vomiting, abdominal pain, or change in mentation but reported polyuria and polydipsia worsening in the months prior. He reported being started on isotretinoin for the treatment of acne 4 months prior. On physical exam, he was mildly tachycardic with stable blood pressure, and signs of dehydration including dry mucous membranes. Labs prior to this visit confirmed hyperglycemia, hypertriglyceridemia, elevated anion gap, low bicarbonate, and elevated ketones concerning for underlying DKA which finally convinced the patient to present to ED where he met the criteria for hospitalization. Isotretinoin was stopped immediately after admission. In spite of a low c-peptide level (0.8 ng/ml) during hospitalization, immunology testing for type 1 diabetes was negative. However, 4 months later a fasting c-peptide increased to a normal level (3.4 ng/ml). Treatment with basal-bolus insulin in the subsequent months markedly improved his diabetes and he was able to achieve HgbA1c of 5.7%. Conclusion: Rapid worsening of diabetes and presentation with DKA is usually associated with a natural course of type 1 diabetes. In the case of our patient who presented with rapid worsening of diabetes, was asymptomatic while in DKA, had negative type 1 diabetes-related antibodies, and presented with marked hypertriglyceridemia. We suspect isotretinoin to be the culprit in the setting of underlining type 2 diabetes. In contrast to reports of isotretinoin increasing insulin resistance, in our case, there was apparently suppression of insulin release. We would like to bring attention to this case with a proposal for close monitoring of the glycemia and lipid levels in patients with underlying diabetes started on isotretinoin. Presentation: Thursday, June 15, 2023