Endocrine Abstracts

JOINT1518

Introduction: Sodium-glucose co-transporter-2 (SGLT2) inhibitors have been recently introduced into heart failure (HF) management and are now pivotal in reducing the mortality and morbidity associated with the condition. SGLT2 receptors, located in the proximal convoluted tubules of the kidneys, are responsible for 90% of total filtered glucose resorption. Inhibiting these receptors results in osmotic diuresis through glucosuria and natriuresis, thus lowering blood pressure and blood sugar levels. However, the mechanism of SGLT2 inhibitors predisposes patients to potential adverse side effects. The aim of this study was to investigate the incidence of diabetic ketoacidosis (DKA), urinary tract infections (UTIs) and acute kidney injury (AKI) in patients on SGLT2 inhibitors.

Methods: This study is a retrospective review of 100 patients with HF who were prescribed either Dapagliflozin or Empagliflozin. Data was extracted using electronic patient records, detailing both inpatient and outpatient treatment. Patients were included in this study based upon a HF diagnosis and treatment involving SGLT2 inhibitors. Adverse events were classified through hospital admissions where DKA, UTI or AKI were diagnosed. Further analysis was conducted in subgroups including diabetic status and type of SGLT2 inhibitor.

Results and Discussion: Amongst the 100 patients (age 31-98 years, 62% males) included in this study, 45% had type-2 diabetes, with a majority (81%) being treated with Dapagliflozin for HF. The incidence of UTIs across the cohort was 16% and 69% of these cases occurred in diabetic patients (risk ratio(RR) = 2.69), indicating that diabetes may increase the likelihood of UTIs in individuals treated with SGLT2 inhibitors. 87% of the total UTI cases occurred in patients on Dapagliflozin (RR = 1.64). AKI developed in 17% of patients, with 53% of cases occurring in diabetic patients (RR = 1.38). The incidence of AKI was also notably higher in patients on Dapagliflozin (RR = 1.64). These results suggest that diabetic patients on Dapagliflozin are at the highest risk of infections when compared with non-diabetic patients. DKA was observed in 3% of the cohort, exclusively in diabetic patients on Dapagliflozin. Our findings display that diabetic patients with HF are at a higher risk for UTIs, DKA and AKI when treated with SGLT2 inhibitors.

Conclusion: In conclusion, our study highlights the need for vigilant monitoring of patients on SGLT2 inhibitors, particularly Dapagliflozin, for adverse events such as UTIs, DKA and AKI. Patients should be counselled prior to initiation of SGLT2 inhibitors, with ongoing glycaemic monitoring, renal function assessments and infection surveillance to mitigate their risk of adverse events.