Dapagliflozin-Associated Diabetic Ketoacidosis
Abstract
To the Editor: In 2015, the Food and Drug Administration issued a drug safety warning for sodium–glucose cotransporter 2 (SGLT2) inhibitors pertaining to the risk of developing diabetic ketoacidosis (DKA) in type 2 diabetes mellitus (T2DM).1 SGLT2 inhibitors such as canagliflozin, dapagliflozin, and empagliflozin belong to a newer class of antihyperglycemic agents that inhibit glucose reuptake in the proximal tubule of the kidney, causing glycosuria, thereby improving glycemic control. Although most cases of DKA were reported with off-label use of SGLT2 inhibitors in patients with type 1 diabetes mellitus, rare cases have also been reported in patients with T2DM. We present a case of SGLT2 inhibitor–associated DKA in a patient with T2DM after initiating therapy with dapagliflozin. A 61-year-old man with a history of T2DM presented to the emergency department with complaints of dizziness. His medication list includes metformin 1000 mg twice daily, glimepiride 8 mg twice daily, and dapagliflozin 5 mg once daily. He was initially started on canagliflozin 6 months before admission, which was switched to dapagliflozin 3 months before admission for insurance-related issues. On admission, he was found to have a hemoglobin A1c level of 8.1%, blood glucose level of 409 mg/dL, serum bicarbonate level of 14 mEq/L, anion gap of 22 mEq/L, pH of 7.34, lactic acid level of 0.8 mmol/L, and urine positive for ketones. He was appropriately managed for DKA, and dapagliflozin was discontinued.…
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