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Euglycemic DKA ID'd in T2DM Patients With COVID-19

TUESDAY, Jan. 5, 2021 -- In a case report recently published in The American Association of Clinical Endocrinologists Clinical Case Reports, five cases of euglycemic diabetic ketoacidosis (euDKA) are described in patients with type 2 diabetes mellitus (T2DM) using sodium glucose cotransporter 2 inhibitors (SGLT2i) who developed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Rebecca J. Vitale, M.D., M.P.H., from Brigham and Women's Hospital in Boston, and colleagues identified a cluster of cases of euDKA in patients with T2DM using SGLT2i who developed SARS-CoV-2 infection.

The researchers identified five cases of euDKA over two months, with presenting glucose <300 mg/dL. All patients had T2DM history, were taking SGLT2i, and had no known history of DKA. On admission, oral antihyperglycemic medications were stopped for all patients. To treat DKA, all received intravenous insulin infusion before being transitioned to a regimen of subcutaneous insulin. For all patients who were discharged, SGLT2i use was discontinued.

"These cases highlight the potential increased danger of SGLT2i use in acute illness with COVID-19," the authors write. "The marked hyperglycemia often seen in COVID-19 and the increased risk of severe disease among those with cardiovascular disease may suggest SGLT2i as a potential therapy during active infection. Our experience suggests that the potential for serious harm may outweigh possible benefit, however, and the current practice to avoid these medications during illness remains prudent. "

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Posted: January 2021

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