Euglycemic DKA (euDKA) as a presentation of COVID-19

Area of Science:

• Endocrinology
• Pharmacology
• Infectious Diseases

Background:

• Sodium-glucose cotransporter 2 (SGLT2) inhibitors are commonly prescribed for type 2 diabetes and heart failure.
• SGLT2 inhibitors lower blood glucose by inhibiting glucose reabsorption in the kidneys.
• Euglycemic diabetic ketoacidosis (DKA) is a rare but serious complication associated with SGLT2 inhibitor use.

Observation:

• The study observed a potential link between SGLT2 inhibitor use and the occurrence of euglycemic DKA in patients with COVID-19.
• This complication may arise independently of typical DKA triggers such as viral illness and dehydration.
• Patients on SGLT2 inhibitors experiencing COVID-19 symptoms warrant close monitoring for DKA.

Findings:

• COVID-19 infection, in patients using SGLT2 inhibitors, can precipitate euglycemic DKA.
• The mechanism may involve altered glucose metabolism and hormonal responses during severe illness.
• This risk appears distinct from DKA precipitated by acute viral illness and dehydration alone.

Implications:

• Clinicians should consider the risk of euglycemic DKA when managing COVID-19 patients on SGLT2 inhibitors.
• Proactive discontinuation of SGLT2 inhibitors in this patient population may be warranted to prevent DKA.
• Further research is needed to elucidate the precise mechanisms and optimal management strategies.