Risk factors of dapagliflozin-associated diabetic ketosis/ketoacidosis in patients with type 2 diabetes mellitus: A matched case-control study. (February 2023)

• Record Type: Journal Article
• Authors: Zhao, Zinan; Zhao, Fei; Zhang, Yatong; Hu, Xin; Li, Jianchun; Tian, Chao; Jin, Pengfei; Liu, Deping
• Is Part Of: Diabetes research and clinical practice. Volume 196(2023)
• Publication Date: 2023-02
• Subjects: Dapagliflozin -- Diabetic ketosis -- Diabetic ketoacidosis -- Euglycemic ketoacidosis -- Risk factor -- Type 2 diabetes mellitus; AUC area under curve -- β-Hb β-hydroxybutyric -- BE base excess -- CAD coronary atherosclerotic heart disease -- CHF chronic heart failure -- Cl- serum chlorine -- CI confidence interval -- CR complete response -- DK diabetic ketosis -- DKA diabetic ketoacidosis -- DPP-4i dipeptidyl peptidase-4 inhibitor -- FBG fasting blood glucose level -- GLP-1RA glucagon-like peptide-1 receptor agonist -- Glu glucose -- HCO3– bicarbonate -- HF heart failure -- HIS hospital information system -- HTN hypertension -- HSA Health Sciences Authority -- ICD international Classification of diseases -- ICU intensive care unit -- IQR interquartile range -- K+ serum potassium -- Ket ketone body -- Lac serum lactate -- Na+ serum sodium -- NSTEMI non-ST elevation myocardial infarction -- OR odds ratio -- pCO2 partial pressure of carbon dioxide -- PD progressive disease -- pO2 partial pressure of oxygen -- PR partial response -- PSM propensity-score matching -- ROC receiver operating characteristic -- SCAD stable cardiovascular disease -- SD stable disease -- Scr serum creatinine -- SGLT2 sodium-glucose cotransporter-2 -- STEMI ST-elevations myocardial infarction -- T2DM type 2 diabetes mellitus -- TIA transient ischemic attacks -- UA unstable angina; Diabetes -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462
• DOI: 10.1016/j.diabres.2023.110236
• Languages: English
• ISSNs: 0168-8227

Abstract

Abstract: Objective: To investigate the risk factors of dapagliflozin-associated diabetic ketosis/ketoacidosis (DK/DKA) in patients with type 2 diabetes mellitus (T2DM). Research Design and Methods: A case-control study was conducted in a general hospital in China from 2018 to 2021. T2DM patients who developed DK/DKA after dapagliflozin treatment were identified. Each patient in the DA/DKA group was matched with a patient in the non-DK/DKA group in terms of the baseline characteristics. Receiver operating characteristic (ROC) curve analysis and logistic regressions were performed. Results: Out of 1, 684 hospitalized patients taking dapagliflozin, 170 were diagnosed with dapagliflozin-associated DK/DKA. A total of 137 cases were matched with 137 controls. The mean time-to-onset (TTO) of DK/DKA was 28.59 days. Logistic regression showed that current drinking (OR = 7.656, p < 0.001), T2DM duration ≥ 7.625 years (OR = 2.399, p = 0.017), acute ST-elevations myocardial infarction (STEMI) (OR = 12.770, p = 0.028), acute infection (OR = 2.862, p = 0.043), insulin dose reduction/cessation before dapagliflozin exposure (OR = 6.751, p < 0.001), and a major plus or major operation (OR = 2.652, p = 0.022) were risk factors for dapagliflozin-associated DK/DKA. Furthermore, T2DM duration ≥ 7.625 years ( p = 0.046) and acute STEMI ( p < 0.001) were independently associated with more severe DK/DKA. Conclusion: Current drinking, long T2DM duration, STEMI, acute infection, insulin deficiency, and major operation are the risk factors associated with DK/DKA in T2DM patients. Furthermore, long T2DM duration and STEMI were associated with more severe DK/DKA situations.