Strategy for Mitigating DKA Risk in Patients with Type 1 Diabetes on Adjunctive Treatment with SGLT Inhibitors: A STICH Protocol
Abstract
iabetic 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.2][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. 4 Recent 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 <2% of older patients.DKA rates generally increased with inadequate glucose control, occurring most often in patients with A1C ‡9.0%.Overall, 2.3% of insulin pump users and 4.3% of those using multiple daily insulin injections (MDI) reported DKA. 5 The T1D Exchange 5-year follow-up data ( 2018) are consistent with these findings and highlight the higher prevalence with increasing A1C values (presented at T1D Exchange Annual meeting, March 2018, Tampa Bay, Florida).That DKA occurs more frequently among patients using MDI…
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