Further warning on SGLT2 inhibitor use and DKA risk in COVID-19

A study from Boston’s Brigham and Women’s Hospital suggests that people with severe COVID-19 disease should refrain from taking sodium-glucose cotransporter (SGLT)-2 inhibitors. Based on a case series study involving three men and two women prescribed SGLT-2 inhibitors for their type 2 diabetes, the drugs may put coronavirus patients at an elevated risk for euglycemic diabetic ketoacidosis (euDKA) even when presenting glucose levels below 300 mg/dL. SGLT-2 inhibitors, which are diuretics, likely contribute to euDKA because of the associated increase in urinary glucose excretion. In addition, researchers suspect that coronavirus may lower insulin secretion. DKA typically correlates to an underlying state of starvation that may be triggered by vomiting, diarrhea, loss of appetite, and reduced nutritional intake. Naomi D.L. Fisher, MD, the study’s senior author, says euDKA appears to be preventable simply by discontinuing the regimen in COVID-19 patients who experience these symptoms. They can resume the medication once they are feeling better and eating and drinking normally. On the other hand, she notes, there is no need to suspend SGLT-2 inhibitor use as long as patients are eating and drinking as usual and exhibiting mild or no COVID-19 symptoms. The study appears in AACE Clinical Case Reports.