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[Considerations on treatment with SGLT2 inhibitor during acute illness]

Gudrun Höskuldsdóttir1, Sigurdur James Thorleifsson2, Annica Ravn-Fischer3

  • 1överläkare, VO specialistmedicin, Sahlgrenska universitetssjukhuset, Göteborg.

Lakartidningen
|January 10, 2023
PubMed

Insights

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are effective for type 2 diabetes, heart failure, and kidney disease. However, they should be temporarily stopped during acute illness to prevent ketoacidosis.

Area of Science:

  • Endocrinology
  • Cardiology
  • Nephrology

Context:

  • Sodium-glucose cotransporter 2 (SGLT2) inhibitors are increasingly used for type 2 diabetes, heart failure, and chronic kidney disease.
  • Key clinical trials establishing SGLT2 inhibitor guidelines excluded patients with acute illness, leaving a gap in evidence for acute care settings.
  • Treatment initiation is advised for stable patients, not during acute conditions that elevate insulin resistance and insulin demand.

Purpose:

  • To review the evidence and provide guidance on the use of SGLT2 inhibitors during acute illness.
  • To highlight the risk of ketoacidosis in patients with diabetes on SGLT2 inhibitors during acute illness.

Summary:

  • SGLT2 inhibitors are crucial for managing type 2 diabetes, heart failure, and chronic kidney disease.
  • Evidence for SGLT2 inhibitor use during acute illness is limited.
  • Acute illness can increase insulin resistance, potentially leading to ketoacidosis in patients on SGLT2 inhibitors, especially with insulin deficiency.

Impact:

  • Temporary discontinuation of SGLT2 inhibitors during acute illness is recommended to mitigate the risk of ketoacidosis.
  • This guidance aims to improve patient safety and optimize treatment strategies in complex clinical scenarios.

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