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Strategy for Mitigating DKA Risk in Patients with Type 1 Diabetes on Adjunctive Treatment with SGLT Inhibitors: A STICH Protocol

2018; Mary Ann Liebert, Inc.; Volume: 20; Issue: 9 Linguagem: Inglês

10.1089/dia.2018.0246

1557-8593

Satish K. Garg, Anne L. Peters, John B. Buse, Thomas Danne,

Diabetes Management and Research

Diabetes Technology & TherapeuticsVol. 20, No. 9 EditorialFree AccessStrategy for Mitigating DKA Risk in Patients with Type 1 Diabetes on Adjunctive Treatment with SGLT Inhibitors: A STICH ProtocolSatish K. Garg, Anne L. Peters, John B. Buse, and Thomas DanneSatish K. GargAddress correspondence to:Satish K. Garg, MDUniversity of Colorado DenverBarbara Davis Center for Diabetes1775 Aurora Court, A140Aurora, CO 80045ColoradoE-mail Address: satish.garg@ucdenver.eduDepartment of Medicine and Pediatrics, School of Medicine, University of Colorado Denver, Aurora, Colorado.Barbara Davis Center for Diabetes, Aurora, Colorado.Search for more papers by this author, Anne L. PetersKeck School of Medicine of the University of Southern California, Los Angeles, California.Search for more papers by this author, John B. BuseUniversity of North Carolina School of Medicine, Chapel Hill, North Carolina.Search for more papers by this author, and Thomas DanneChildren's and Youth Hospital Auf der Bult, Hannover Medical School, Hannover, Germany.Search for more papers by this authorPublished Online:1 Sep 2018https://doi.org/10.1089/dia.2018.0246AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Diabetic ketoacidosis (DKA) is a serious complication of diabetes that occurs primarily in type 1 diabetes (T1D), although it may also affect patients with other forms of insulin-dependent diabetes and may occur in new-onset type 2 diabetes. Insulin deficiency is associated with an increase in glucagon and excessive lipolysis with increased oxidation of fatty acids to ketone bodies in the liver and ketonemia. Ketosis may advance to metabolic acidosis. For DKA to be diagnosed, both ketosis and acidosis must be present.1–3 If not recognized and/or treated early, it can become serious and life-threatening; 168,000 patients were admitted to U.S. hospitals for DKA in 2014.4Recent data from the T1D Exchange, a national registry including >32,000 U.S. children, adolescents, and adults with T1D, shed some light on the background risks of DKA. In a 2015 report, <5% of participants reported experiencing DKA, which occurred most often in children (3%–4%), adolescents 13–17 years of age (4%), and young adults 18–25 years (5%), but in 3.0 mmol/L or significant ketonuria (more than 2+ on standard urine sticks)Blood glucose >200 mg/dL or known diabetes mellitusBicarbonate (HCO3−) <15.0 mmol/L and/or venous pH <7.3It is important to note that blood glucose values may be 3.0 mmol/L, the patient should contact the clinician.DKA is both preventable and manageable. Mitigating the risks of DKA involves building awareness among clinicians and patients about precipitating factors and how to avoid or minimize their impact. Recent innovations in diabetes treatment, including advances in the design of insulin pumps and use of Continuous Glucose Monitoring (CGM) devices as well as longer acting basal insulin formulations, may reduce DKA risk in patients with diabetes treated with intensive, basal-bolus insulin regimens. Among patients using SGLT inhibitors with insulin (currently off-label in T1D), additional education on how and why SGLT2 inhibition may increase DKA risk—and strategies to appropriately monitor and respond to ketosis—can allow patients with T1D and clinicians to safely use this new adjunctive therapeutic approach if approved by regulatory authorities.Author Disclosure StatementSKG reports receiving grant support and travel support from Sanofi, Lexicon, Novo Nordisk, Mannkind, Roche Diagnostics, Zealand, Senseonics Inc., and Medtronic, and grant support paid to his institution from Eli Lilly, Dexcom, and Johnson & Johnson.ALP has participated on advisory boards for Abbott Diabetes Care, Becton Dickinson, Bigfoot, Boehringer Ingelheim, Eli Lilly and Company, Medscape, Merck, Novo Nordisk, Omada Health, and Sanofi; is chair of the type 1 diabetes steering committee at Lexicon; has consulted for Science 37; spoken for and received research supplies from Dexcom; and participated in a speaker's bureau for NovoNordisk.JBB's contracted consulting fees are paid to the University of North Carolina by Adocia, AstraZeneca, Dance Biopharm, Eli Lilly, MannKind, NovaTarg, Novo Nordisk, Senseonics, and vTv Therapeutics; grant support from Novo Nordisk, Sanofi, and vTv Therapeutics. He is a consultant to Neurimmune AG. He holds stock options in Mellitus Health, PhaseBio and Stability Health. He is supported by a grant from the National Institutes of Health (UL1TR002489).T.D. has received research support or has consulted for Abbott, AstraZeneca, Bayer, Boehringer, DexCom, Insulet Corp., Eli Lilly, Medtronic, NovoNordisk, Roche, Sanofi, Ypsomed and is a shareholder of DreaMed.References1 Umpierrez G, Korytkowski M: Diabetic emergencies—ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia. Nat Rev Endocrinol 2016;12:222–232. Crossref, Medline, Google Scholar2 Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN: Hyperglycemic crises in adult patients with diabetes. Diabetes Care 2009;32:1335–1343. Crossref, Medline, Google Scholar3 Dhatariya K, Savage M: The management of diabetic ketoacidosis in adults. 2nd ed. Solihull, West Midlands, UK: Joint British Diabetes Societies Inpatient Care Group, 2013. 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Garg20 February 2019 | Diabetes Technology & Therapeutics, Vol. 21, No. S1 Volume 20Issue 9Sep 2018 InformationCopyright 2018, Mary Ann Liebert, Inc.To cite this article:Satish K. Garg, Anne L. Peters, John B. Buse, and Thomas Danne.Strategy for Mitigating DKA Risk in Patients with Type 1 Diabetes on Adjunctive Treatment with SGLT Inhibitors: A STICH Protocol.Diabetes Technology & Therapeutics.Sep 2018.571-575.http://doi.org/10.1089/dia.2018.0246Published in Volume: 20 Issue 9: September 1, 2018Online Ahead of Print:August 21, 2018PDF download