What question did this study set out to answer?

To assess whether sodium-glucose cotransporter-2 (SGLT-2) inhibitors, compared with dipeptidyl peptidase-4 (DPP-4) inhibitors, are associated with an increased risk for diabetic ketoacidosis in patients with type 2 diabetes.

July 27, 2020Annals of Internal Medicine

Sodium–Glucose Cotransporter-2 Inhibitors and the Risk for Diabetic Ketoacidosis

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Authors

ADAntonios DourosBerlin Institute of Health at Charité - Universitätsmedizin Berlin LLLisa M. LixManitoba Health MFMichael FralickUniversity Health Network

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Implication

Randomized trial reveals increased risk of diabetic ketoacidosis with SGLT-2 inhibitors in type 2 diabetes, highlighting a potential class effect across multiple molecules.

Key Points

To assess whether sodium-glucose cotransporter-2 (SGLT-2) inhibitors, compared with dipeptidyl peptidase-4 (DPP-4) inhibitors, are associated with an increased risk for diabetic ketoacidosis in patients with type 2 diabetes.
Multicenter trial (ClinicalTrials.gov: NCT04017221) conducted between 2013 and 2018 using electronic healthcare databases from 7 Canadian provinces and the United Kingdom.
Matched 208,757 new users of SGLT-2 inhibitors to 208,757 recipients of DPP-4 inhibitors using time-conditional propensity scores.
Estimated site-specific hazard ratios (HRs) of diabetic ketoacidosis with Cox proportional hazards models and pooled results using random-effects models.
Overall, 521 patients developed diabetic ketoacidosis during 370,454 person-years of follow-up, corresponding to an incidence rate of 1.40 per 1000 person-years (95% CI, 1.29 to 1.53).
SGLT-2 inhibitors were associated with an elevated risk for diabetic ketoacidosis compared with DPP-4 inhibitors (incidence rate, 2.03 [95% CI, 1.83 to 2.25] vs. 0.75 [95% CI, 0.63 to 0.89] per 1000 person-years; HR, 2.85 [95% CI, 1.99 to 4.08]).
Molecule-specific analyses revealed heightened risk for dapagliflozin (HR, 1.86 [95% CI, 1.11 to 3.10]), empagliflozin (HR, 2.52 [95% CI, 1.23 to 5.14]), and canagliflozin (HR, 3.58 [95% CI, 2.13 to 6.03]).

Cite This Study

Douros et al. (2020) studied this question.

synapsesocial.com/papers/6a723852f44fa9f079dfc621 https://doi.org/10.7326/m20-0289

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Implication

Randomized trial reveals increased risk of diabetic ketoacidosis with SGLT-2 inhibitors in type 2 diabetes, highlighting a potential class effect across multiple molecules.

Sodium–Glucose Cotransporter-2 Inhibitors and the Risk for Diabetic Ketoacidosis

Discussion

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Implication

Key Points

Cite This Study

Sodium–Glucose Cotransporter-2 Inhibitors and the Risk for Diabetic Ketoacidosis

Discussion

Member takes

Implication

Key Points

Cite This Study

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