Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Diabetes

SGLT2 inhibitors and diabetic ketoacidosis — a growing concern

Diabetic ketoacidosis is a worrying complication associated with the use of sodium/glucose cotransporter 2 (SGLT2) inhibitors in patients with type 1 diabetes mellitus (T1DM) or T2DM. A recent analysis of data in the FDA Adverse Event Reporting System by Fadini and colleagues adds to this concern.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

References

  1. Tahrani, A. A., Barnett, A. H. & Bailey, C. J. SGLT inhibitors in management of diabetes. Lancet Diabetes Endocrinol. 1, 140–151 (2013).

    Article  CAS  Google Scholar 

  2. Zinman, B. et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N. Engl. J. Med. 373, 2117–2128 (2015).

    Article  CAS  Google Scholar 

  3. Rodbard, H. W. et al. The effect of canagliflozin, a sodium glucose cotransporter 2 inhibitor, on glycemic end points assessed by continuous glucose monitoring and patient-reported outcomes among people with type 1 diabetes. Diabetes Care 40, 171–180 (2017).

    Article  CAS  Google Scholar 

  4. Umpierrez, G. & Korytkowski, M. Diabetic emergencies — ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia. Nat. Rev. Endocrinol. 12, 222–232 (2016).

    Article  CAS  Google Scholar 

  5. U.S. Food and Drug Administration. FDA warns that SGLT2 inhibitors for diabetes may result in a serious condition of too much acid in the blood. FDA http://www.fda.gov/downloads/Drugs/DrugSafety/UCM446954.pdf (2015).

  6. European Medicines Agency. Review of diabetes medicines called SGLT2 inhibitors started: risk of diabetic ketoacidosis to be examined. EMA http://www.ema.europa.eu/docs/en_GB/document_library/Referrals_document/SGLT2_inhibitors__20/Procedure_started/WC500187926.pdf (2015).

  7. Hayami, T. et al. Case of ketoacidosis by a sodium–glucose cotransporter 2 inhibitor in a diabetic patient with a low-carbohydrate diet. J. Diabetes Investig. 6, 587–590 (2015).

    Article  Google Scholar 

  8. Erondu, N., Desai, M., Ways, K. & Meininger, G. Diabetic ketoacidosis and related events in the Canagliflozin Type 2 Diabetes Clinical Program. Diabetes Care 38, 1680–1686 (2015).

    Article  CAS  Google Scholar 

  9. Henry, R. R., Thakkar, P., Tong, C., Polidori, D. & Alba, M. Efficacy and safety of Canagliflozin, a sodium–glucose cotransporter 2 inhibitor, as add-on to insulin in patients with type 1 diabetes. Diabetes Care 38, 2258–2265 (2015).

    Article  CAS  Google Scholar 

  10. Fadini, G. P., Bonora, B. M. & Avogaro, A. SGLT2 inhibitors and diabetic ketoacidosis: data from the FDA Adverse Event Reporting System. Diabetologia http://dx.doi.org/10.1007/s00125-017-4301-8 (2017).

    Google Scholar 

Download references

Acknowledgements

G.E.U. is partly supported by research grants from the Public Health Service (Grant UL1 RR025008 from the Clinical and Translational Science Award program), and the US National Institutes of Health and National Center for Research Resources (1P30DK111024-01).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Guillermo E. Umpierrez.

Ethics declarations

Competing interests

G.E.U. has received unrestricted research support for investigator-initiated studies (paid to Emory University) from AstraZeneca, Boehringer Ingelheim, Merck, Novo Nordisk and Sanofi.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Umpierrez, G. SGLT2 inhibitors and diabetic ketoacidosis — a growing concern. Nat Rev Endocrinol 13, 441–442 (2017). https://doi.org/10.1038/nrendo.2017.77

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrendo.2017.77

This article is cited by

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing