SGLT‐2 inhibitors and high‐dose acarbose as potential high‐risk combinations for ketosis and ketoacidosis in Asian patients with T2DM: A case series

Autor: Wei Qiang, Fei Yang, Ling Liu, Ruiqing Dong, Yushi Sun, Ahona Mondal, Hui Guo
Jazyk: angličtina
Rok vydání: 2024
Předmět:
Zdroj: Clinical Case Reports, Vol 12, Iss 9, Pp n/a-n/a (2024)
Druh dokumentu: article
ISSN: 2050-0904
DOI: 10.1002/ccr3.9282
Popis: Key Clinical Message High‐dose acarbose may increase the risk of diabetic ketosis/diabetic ketoacidosis in Asian patients on sodium‐glucose cotransporter‐2 inhibitors. Healthcare providers and patients should be cautious to avoid this combination. Abstract Low‐calorie diets should be avoided in patients receiving sodium‐glucose cotransporter‐2 (SGLT‐2) inhibitors to decrease the risk of diabetic ketoacidosis (DKA). High‐dose acarbose can decelerate carbohydrate absorption. We detail three cases of diabetic ketosis (DK) following concurrent SGLT‐2 inhibitor and high‐dose acarbose therapy (acarbose 300 mg/day and dapagliflozin 10 mg/day). Patients, aged 38–63 years with 3–10 years of type 2 diabetes mellitus (T2DM), developed DK, indicated by moderate urinary ketones and high glucose (urine ketone 2+ to 3+ and glucose 3+ to 4+) without acidosis, within 4 days to 1 month post‐therapy initiation. Serum glucose was 172.8–253.8 mg/dL; HbA1c was 9.97%–10.80%. The combination therapy was halted, and DK was managed with low‐dose intravenous insulin and fluids, followed by intensive insulin therapy. High‐dose acarbose with SGLT‐2 inhibitors may increase the risk of DK/DKA in Asian patients.
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