Endocrine Abstracts

JOINT1730

Introduction: Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes, typically characterized by severe hyperglycemia. However, with the increasing use of sodium-glucose linked transporter 2 inhibitors (SGLT2i) now widely prescribed for type 2 diabetes as well as chronic kidney disease and heart failure, there has been a rise in euglycemic diabetic ketoacidosis (euDKA). Unlike classical DKA, euDKA presents with only mild to moderate hyperglycemia, typically defined as a blood glucose level below 250 mg/dL (13.9 mmol/l).

Case series: We present a series of eight patients diagnosed with euDKA during inpatient endocrinology consultations at our institution between 2019 and the end of 2024. The median patient age was 62 years [range 43–74]. At presentation, the median blood glucose level was 189 mg/dL (10.5 mmol/l) [range 92–241 mg/dL; 5.1–13.4 mmol/l], and the median arterial pH was 7.21 [range 7.04–7.29]. All patients had a pre-existing diagnosis of type 2 diabetes mellitus. Half of the patients were hospitalised for major surgical procedures, while the other half presented with severe infections. All patients received standard DKA treatment and were subsequently discharged. Upon discharge, three patients remained on insulin therapy, while the rest continued oral treatment, either alone or in combination with glucagon-like peptide-1 (GLP-1) receptor agonists.

Conclusion: SGLT2i presents a major new contribution in the therapy of patients with type 2 diabetes as well as patients with chronic kidney disease or heart failure without type 2 diabetes. However, given their expanding indications, clinicians must remain vigilant for potential adverse effects, including euDKA. SGLT2i therapy should be temporarily discontinued during severe infections and at least three days before the major surgery to reduce the risk.