Sodium–glucose cotransporter type 2 (SGLT2) inhibitors are an emerging oral glucose-lowering therapy. In May 2015, the United States Food and Drug Administration issued a warning amid observation of ketoacidosis cases that may have been associated with SGLT2 inhibitor use in people with type 2 diabetes (T2DM). Potential mechanisms include inhibition of insulin secretion through glycosuria, increased glucagon secretion and hypovolaemia.1-3
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- 1. Bonner C, Kerr-Conte J, Gmyr V, et al. Inhibition of the glucose transporter SGLT2 with dapagliflozin in pancreatic alpha cells triggers glucagon secretion. Nat Med 2015; 21: 512-517.
- 2. Alberti KG, Johnston DG, Gill A, et al. Hormonal regulation of ketone-body metabolism in man. Biochem Soc Symp 1978; 43: 163-182.
- 3. Ogawa W, Sakaguchi K. Euglycemic diabetic ketoacidosis induced by SGLT2 inhibitors: possible mechanism and contributing factors. J Diabetes Investig 2016; 7: 135-138.
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We thank our two patients for kindly allowing us to describe their cases.
No relevant disclosures.