SGLT2 inhibitors show no significant risk of DKA, study reports

Adults with type 2 diabetes who take SGLT2 inhibitors are less likely to experience diabetic ketoacidosis (DKA) than those on insulin treatment, a study suggests.
These findings existed for those with type 2 diabetes either prescribed SGLT2 inhibitors as a single treatment or in combination with another drug.
Scientists from the Steno Diabetes Center, Copenhage, Denmark examined 415,670 people with type 2 diabetes during 1995-2014, all of whom were treated with medication, including insulin.
They sought to evaluate the rates of DKA within patients to assess if any association could be made between DKA, a dangerous short-term complication, and SGLT2 inhibitors.
SGLT2 inhibitors work by helping the kidneys to lower blood glucose levels, with excess blood glucose removed through urine.
During follow-up, 4,045 first events of DKA were identified, but this incidence went on to decrease by 5.6 per cent per year.
The risk of DKA was highest for people on insulin, followed by people who were on a combination of insulin and oral diabetes drugs.
Those who filled prescriptions for SGLT2 inhibitors had no registered events of DKA, while six events of DKA occurred in those who were treated with an SGLT2 combination treatment.
The researchers said: “This is the first study to estimate nationwide incidence of DKA in type 2 diabetes with 20 years of follow-up and three million person-years of observation combined with prescription data.
“Compared with canagliflozin trials, our DKA incidence rates in the SGLT2 inhibitor-treated groups are higher, but the rates presented here indicate what we are likely to face in clinical practice; out of 1,000 people classified as having type 2 diabetes, one will be hospitalised with DKA each year, a potentially life-threatening acute situation, especially in the older population, demanding hospital admission and intensive treatment.
“The excess risk associated with SGLT2 inhibitor treatment was, however, not significant and is hardly clinically relevant.”
The study has been published online in Diabetes Care.