SGLT2 inhibitors: risk of diabetic ketoacidosis

Serious and life-threatening cases of diabetic ketoacidosis have been reported in patients taking SGLT2 inhibitors. In several cases, blood glucose levels were only moderately elevated (eg, <14 mmol/L or 250mg/dL), which is atypical for diabetic ketoacidosis. 

The MHRA has issued the following recommendations for prescribers:

• Test for raised ketones in patients with symptoms of diabetic ketoacidosis, even if plasma glucose levels are near-normal. 
• Discontinue treatment if diabetic ketoacidosis is suspected. 
• If diabetic ketoacidosis is confirmed, take appropriate corrective measures and monitor glucose levels.
• Continue to report suspected side-effects of SGLT2 inhibitors.

Further information
MHRA Drug Safety Update 
View SGLT2 inhibitor drug records

To avoid a delay in diagnosis and treatment of diabetic ketoacidosis, prescribers should inform patients of the symptoms and signs:

• nausea
• vomiting
• anorexia
• abdominal pain
• excessive thirst
• difficulty breathing
• confusion
• unusual fatigue or sleepiness.

Prescribers are reminded that SGLT2 inhibitors are not approved for the treatment of type I diabetes.