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https://www.readbyqxmd.com/read/29732161/rapid-onset-diabetic-ketoacidosis-secondary-to-nivolumab-therapy
#1
Senhong Lee, Aparna Morgan, Sonali Shah, Peter R Ebeling
We report a case of a 67-year-old man with type 2 diabetes presented with diabetic ketoacidosis, two weeks after his first dose of nivolumab therapy for non-small-cell lung carcinoma. He was started on empagliflozin two days prior in the setting of hyperglycaemia after the initiation of nivolumab therapy. Laboratory evaluation revealed an undetectable C-peptide and a positive anti-glutamic acid decarboxylase (GAD) antibody. He was treated with intravenous fluids and insulin infusion and was subsequently transitioned to subcutaneous insulin and discharged home...
2018: Endocrinology, Diabetes & Metabolism Case Reports
https://www.readbyqxmd.com/read/29663292/the-potential-role-of-sglt2-inhibitors-in-the-treatment-of-type-1-diabetes-mellitus
#2
Hadi Fattah, Volker Vallon
Type 1 diabetes mellitus is a difficult disease to treat due to the relative paucity of therapeutic options other than injectable insulin. The latter, however, can induce hypoglycemia, which has been linked to enhanced cardiovascular risk. Sodium glucose cotransporter 2 (SGLT2) inhibitors are a new class of oral anti-hyperglycemic medications that do not increase the hypoglycemia risk and are US Food and Drug Administration (FDA) approved in type 2 diabetes mellitus. SGLT2 inhibitors may also be of benefit in type 1 diabetic patients, in addition to insulin, although they have not yet been approved for this indication...
April 16, 2018: Drugs
https://www.readbyqxmd.com/read/29625780/pharmacovigilance-of-sodium-glucose-co-transporter-2-inhibitors-what-a-clinician-should-know-on-disproportionality-analysis-of-spontaneous-reporting-systems
#3
E Raschi, E Poluzzi, F Salvo, A Pariente, F De Ponti, G Marchesini, U Moretti
Sodium-glucose co-transporter-2 inhibitors (SGLT2-Is) have consistently demonstrated a clinically significant reduction of cardiovascular mortality. However, their safety in clinical practice is still incompletely characterized, and post-marketing monitoring is required considering the expected increase in clinical use. Different analyses of international spontaneous reporting systems, known as disproportionality analyses (DAs), have highlighted the occurrence of ketoacidosis, amputations, acute renal failure and skin toxicity...
March 1, 2018: Nutrition, Metabolism, and Cardiovascular Diseases: NMCD
https://www.readbyqxmd.com/read/29602453/sglt2-inhibitor-induced-euglycaemic-diabetic-ketoacidosis-may-be-due-to-abrupt-severe-and-transient-impaired-glucose-sensing-in-susceptible-individuals-with-a-hitherto-unrecognised-beta-cell-sglt-variant
#4
F M Finucane
Euglycaemic diabetic ketoacidosis (EDKA) is a rare complication of treatment with SGLT2 inhibitors in patients with type 2 diabetes. Uncertainty remains about its precise mechanistic basis, but the physiological derangement is acute and profound, yet reversible with cessation of the drug. It is reminiscent of other "non type 1" presentations with DKA such as ketosis prone diabetes, except that glucose levels are usually normal. Impaired beta cell glucose sensing that mimicked a state of hypoglycaemia could theoretically lead to abrupt and transient cessation of insulin secretion...
May 2018: Medical Hypotheses
https://www.readbyqxmd.com/read/29542418/diabetic-ketoacidosis-in-patients-with-type-2-diabetes-on-sodium-glucose-cotransporter-2-inhibitors-a-case-series
#5
Purva Sharma, Yash Jobanputra, Karen Lewin, Stuart Bagatell, Daniel Lichtstein
BACKGROUND: Diabetic ketoacidosis (DKA) is a serious complication of diabetes seen commonly in autoimmune Type 1 diabetes mellitus (DM), however patients with Type 2 diabetes are also at risk. Diabetic ketoacidosis may be precipitated by the catabolic stress of acute illness such as trauma, surgery, or infections. Recent studies have suggested that sodium glucose cotransporter-2 (SGLT-2) inhibitors precipitate DKA in Type 2 diabetes. We present a case series of four patients on SGLT-2 inhibitors who presented with DKA...
March 13, 2018: Reviews on Recent Clinical Trials
https://www.readbyqxmd.com/read/29529345/sodium-glucose-co-transporter-type-2-inhibitors-pharmacology-and-peri-operative-considerations
#6
REVIEW
D A Milder, T Y Milder, P C A Kam
Sodium-glucose co-transporter 2 (SGLT2) inhibitors are an emerging class of oral hypoglycaemic agents with therapeutic benefits beyond better glycaemic control. A major concern of the sodium-glucose co-transporter 2 inhibitors is their propensity to cause euglycaemic ketoacidosis in the peri-operative period and the potential for this critical diagnosis to be delayed or missed entirely. This review attempts to collate the case reports of sodium-glucose co-transporter 2 inhibitor ketoacidosis associated with surgery to highlight and put a perspective on this peri-operative issue...
March 12, 2018: Anaesthesia
https://www.readbyqxmd.com/read/29485006/risks-associated-with-sglt2-inhibitors-an-overview
#7
Mahakpreet Singh, Anoop Kumar
Sodium glucose co-transport 2 inhibitors (SGLT2-i) are the new class of anti-diabetic medications which are the recently approved (2013) by FDA for the treatment of diabetes. These inhibitors block the SGLT2 protein which involved in glucose reabsorption from proximal renal tubule which results in increased glucose excretion and lower blood glucose levels. These inhibitors exert favourable effects beyond glucose control such as consistent body weight, blood pressure, and serum uric acid reductions. Canagliflozin, Dapagliflozin, and Empagliflozin belong to the class of SGLT2 inhibitors...
February 25, 2018: Current Drug Safety
https://www.readbyqxmd.com/read/29451721/sodium-glucose-co-transporter-2-inhibitors-as-add-on-therapy-to-insulin-for-type-1-diabetes-mellitus-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#8
Tomohide Yamada, Nobuhiro Shojima, Hisashi Noma, Toshimasa Yamauchi, Takashi Kadowaki
New treatments for type 1 diabetes are an unmet need. We investigated the efficacy and safety of adding sodium-glucose co-transporter-2 (SGLT2) inhibitors to insulin for type 1 diabetes by conducting a meta-analysis of prospective randomized, placebo-controlled trials. A search of electronic databases up to October 2017 identified 1361 studies, of which 14 were investigated (N = 4591). Meta-analysis showed that SGLT2 inhibitor therapy significantly reduced glycated haemoglobin (HbA1c) concentration by 0.4% (95% confidence interval [CI] 0...
February 16, 2018: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/29320602/when-metformin-is-not-enough-pros-and-cons-of-sglt2-and-dpp-4-inhibitors-as-a-second-line-therapy
#9
REVIEW
Angelo Avogaro, Elías Delgado, Ildiko Lingvay
The newer oral therapies for type 2 diabetes mellitus, dipeptidyl peptidase-4 (DPP-4) inhibitors and sodium glucose cotransporter 2 (SGLT2) inhibitors, have advantages over older agents. Dipeptidyl peptidase-4 inhibitors are weight neutral and have few adverse effects. Sodium glucose cotransporter 2 inhibitors have additional benefits: weight loss, blood pressure reduction, cardiovascular risk reduction, and renoprotective effects. Sodium glucose cotransporter 2 inhibitors have increased risk of urogenital infections and possible risk of "euglycaemic" diabetic ketoacidosis...
January 10, 2018: Diabetes/metabolism Research and Reviews
https://www.readbyqxmd.com/read/29212386/efficacy-and-safety-of-sotagliflozin-in-treating-diabetes-type-1
#10
Marc S Rendell
Sotagliflozin is the first dual SGLT1/SGLT2 inhibitor developed for use in diabetes. Sotagliflozin blocks SGLT2 in the kidneys and SGLT1 in the intestines resulting in reduced early phase glucose absorption and increased blood levels of GLP-1 and PYY. Urinary glucose excretion is lower than with other agents as a result of decreased glucose absorption. The primary development effort to date has been in Type 1 diabetes. Areas covered: The published information on sotagliflozin is reviewed, along with the recent results of several pivotal Type 1 diabetes trials...
February 2018: Expert Opinion on Pharmacotherapy
https://www.readbyqxmd.com/read/29183654/-safety-of-sglt2-inhibitors-a-review-of-the-adverse-drug-reactions-registered-in-a-national-database
#11
O Esteban-Jiménez, C Navarro-Pemán, L Urieta-González
OBJECTIVE: To analyse the adverse drug reactions (ADRs) caused by Sodium-glucose Cotransporter-2 Inhibitors (SGLT2i) notified in Spain since they have been on the market. MATERIAL AND METHODS: An analysis was made of all the notifications registered in the Spanish Pharmacovigilance System of drugs for human use, arising from the use of SGLT2i. RESULTS: A total of 311 notifications were recorded, of which 169 (54.34%) were related to dapagliflozin, 81 (26...
January 2018: Semergen
https://www.readbyqxmd.com/read/29157798/euglycemic-diabetic-ketoacidosis-secondary-to-dapagliflozin-use-a-case-report
#12
Felicity Brown, Tamara McColl
BACKGROUND: Sodium-glucose co-transporter-2 (SGLT2) inhibitors are a novel class of oral antihyperglycemic agents. They are associated with rare cases of euglycemic diabetic ketoacidosis (DKA), which presents a diagnostic challenge in the emergency department (ED) and potentially severe consequences if missed. CASE REPORT: A 53-year-old man with type 2 diabetes mellitus and a recent Roux-en-Y gastric bypass surgery presented to the ED with nausea, vomiting, and generalized abdominal pain...
January 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29074329/degree-of-ketonaemia-and-its-association-with-insulin-resistance-after-dapagliflozin-treatment-in-type-2-diabetes
#13
S H Min, T J Oh, S-I Baek, D-H Lee, K M Kim, J H Moon, S H Choi, K S Park, H C Jang, S Lim
BACKGROUND: Euglycaemic ketoacidosis has been reported after sodium-glucose cotransporter 2 (SGLT2) inhibitor treatment. However, the degree of ketonaemia and its metabolic effects have not been well investigated. Our study examined the degree of ketonaemia induced by SGLT2 inhibition and its association with metabolic profiles in type 2 diabetes mellitus (T2DM). METHODS: Biochemical parameters, including insulin, glucagon, free fatty acid (FFA), β-hydroxybutyrate (BHB) and acetoacetate (ACA) levels, were measured in 119 T2DM patients after dapagliflozin treatment for>3 months, and compared with a matched control group...
February 2018: Diabetes & Metabolism
https://www.readbyqxmd.com/read/29068709/altered-patterns-of-early-metabolic-decompensation-in-type-1-diabetes-during-treatment-with-a-sglt2-inhibitor-an-insulin-pump-suspension-study
#14
Neha S Patel, Michelle A Van Name, Eda Cengiz, Lori R Carria, Stuart A Weinzimer, William V Tamborlane, Jennifer L Sherr
BACKGROUND: Enthusiasm for the benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2i) as an adjunctive treatment in type 1 diabetes (T1D) has been offset by the possible increased risk of diabetic ketoacidosis (DKA). Since pump-treated T1D patients are susceptible to DKA due to infusion site problems, this study was undertaken to assess how treatment with SGLT2i affects patterns of early metabolic decompensation following suspension of basal insulin. METHODS: Ten T1D participants (age 19-35 years, duration 10 ± 8 years, A1c 7...
November 2017: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/29039237/sglt2-inhibitors-are-they-safe
#15
REVIEW
Sebastian Filippas-Ntekouan, Theodosios D Filippatos, Moses S Elisaf
Sodium-glucose linked transporter type 2 (SGLT2) inhibitors are a relatively new class of antidiabetic drugs with positive cardiovascular and kidney effects. The aim of this review is to present the safety issues associated with SGLT2 inhibitors. Urogenital infections are the most frequently encountered adverse events, although tend to be mild to moderate and are easily manageable with standard treatment. Although no increased acute kidney injury risk was evident in the major trials, the mechanism of action of these drugs requires caution when they are administered in patients with extracellular volume depletion or with drugs affecting renal hemodynamics...
January 2018: Postgraduate Medicine
https://www.readbyqxmd.com/read/28864828/-severe-atypical-ketoacidosis-due-to-sglt2-inhibitor-therapy-two-case-reports
#16
T G K Breuer, K Kampmann, A Wutzler, C Steinfort, W Uhl, W E Schmidt, J J Meier
Two female patients were admitted due to ketoacidosis. Serum glucose was moderately elevated. The patients exhibited abdominal and neurologic symptoms. Treatment consisted of metformin, insulin glargin and empagliflozin, as well as glimepiride, insulin detemir and empagliflozin, respectively. Treatment with intravenous fluid replacement, insulin, glucose, potassium and buffer solution led to a normalisation of pH and serum glucose levels. Our report describes two cases of atypical ketoacidosis with moderately elevated serum glucose during sodium-glucose co-transporter-2 (SGLT2) inhibitor therapy...
March 2018: Der Internist
https://www.readbyqxmd.com/read/28856166/ketoacidosis-with-canagliflozin-prescribed-for-phosphoinositide-3-kinase-inhibitor-induced-hyperglycemia-a-case-report
#17
Christopher Bowman, Vandana Abramson, Melissa Wellons
Context. Many phosphoinositide-3-kinase (PI3K) inhibitors are under trial for cancer treatment. We present a patient taking taselisib who developed ketoacidosis within 1 week of starting canagliflozin. Case Description. A 69-year-old female patient with no previous history of diabetes mellitus was enrolled in a clinical trial for taselisib therapy in stage IV breast cancer. Hyperglycemia treatment with metformin was insufficient and not tolerated. The addition of canagliflozin daily resulted in ketoacidosis and hospitalization within 1 week...
July 2017: Journal of Investigative Medicine High Impact Case Reports
https://www.readbyqxmd.com/read/28797889/insights-into-the-recognition-and-management-of-sglt2-inhibitor-associated-ketoacidosis-it-s-not-just-euglycemic-diabetic-ketoacidosis
#18
Stephanie Dizon, Erin J Keely, Janine Malcolm, Amel Arnaout
No abstract text is available yet for this article.
October 2017: Canadian Journal of Diabetes
https://www.readbyqxmd.com/read/28760225/renal-safety-profile-of-sodium-glucose-cotransporter-2-inhibitors-and-other-safety-data
#19
Pablo Gómez-Fernández, Diego Fernández-García
The main effect of SGLT2 inhibitors is their glycosuric action. These drugs reverse the deleterious effect of increased glucose reabsorption by the renal tubule in persons with DM2. In terms of efficacy, SGLT2 inhibitors produce a mean HbA1c reduction of 0.8%, although higher initial HbA1c levels can show a larger decrease. In addition to these glycaemic effects, this drug class also favours weight loss and blood pressure control, without increasing hypoglycaemic episodes. Due to their insulin-independent mechanism of action, SGLT2 inhibitors can be used in monotherapy, in patients with metformin intolerance, or in combination with other glucose-lowering drugs, including insulin...
November 2016: Medicina Clínica
https://www.readbyqxmd.com/read/28748724/acid-base-and-electrolyte-disorders-associated-with-the-use-of-antidiabetic-drugs
#20
REVIEW
Theodosios Filippatos, Eleftheria Tzavella, Christos Rizos, Moses Elisaf, George Liamis
The use of antidiabetic drugs is expected to substantially increase since diabetes mellitus incidence rises. Currently used antidiabetic drugs have a positive safety profile, but they are associated with certain acid-base and electrolyte abnormalities. The aim of the review is to present the current data regarding the antidiabetic drugs-associated acid-base and electrolyte abnormalities. Areas covered: Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been linked with the scarce, but serious, complication of euglycemic diabetic ketoacidosis, as well as with an increase in serum potassium, magnesium and phosphorus levels...
October 2017: Expert Opinion on Drug Safety
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