'Understand This Warning': SGLT2s and Ketoacidosis

Hi. I'm Dr Anne Peters. Today I'm going to talk about the US Food and Drug Administration's (FDA) warning about the development of diabetic ketoacidosis (DKA) in individuals taking SGLT2 inhibitors.^[1] The most important headline about this is that it can occur and it seems to be a rare occurrence, therefore people miss it. It's important that physicians in the emergency department and urgent care settings, as well as the rest of us, realize that a patient with either type 1 or type 2 diabetes who presents with anion gap metabolic acidosis can have ketoacidosis. Once that is recognized, the treatment becomes simple, which is intravenous insulin and glucose. However, many of these patients are euglycemic, so providers aren't tipped into thinking that it's ketoacidosis. They think it's something else. It is very important that we be aware that this can happen so that we can recognize it and treat it appropriately.^[2]

I also want to make it clear that I think SGLT2 inhibitors are great drugs for the treatment of type 2 diabetes and they should continue to be used, but people need to be aware that they can cause ketoacidosis. They are also used off label for the treatment of type 1 diabetes.