ArticleAACE clinical case reports
Euglycemic Diabetic Ketoacidosis With COVID-19 Infection in Patients With Type 2 Diabetes Taking SGLT2 Inhibitors.
Article in AACE clinical case reports. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 1 of them a synthesis that pooled it.
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Who cites it
23 citing papers in PubMed, 1 synthesis or guideline pooled it, 54 citations in OpenAlex.
- Managing diabetes in diabetic patients with COVID: where do we start from?Acta diabetologica · 2021Pooled it
- The Effect of Sodium-Glucose Cotransporter-2 Inhibitors on COVID-19 Patients with Type 2 Diabetes Mellitus: A Retrospective Cohort Study Using the Common Data Model.Journal of clinical medicine · 2024Article
- Can euglycemic Diabetic Ketoacidosis Caused by SGLT2 Inhibitors be avoided in Covid-19 and other acute Infections?European journal of case reports in internal medicine · 2024Article
- Antidiabetic Drug Efficacy in Reduction of Mortality during the COVID-19 Pandemic.Medicina (Kaunas, Lithuania) · 2023Review
- Sodium-glucose cotransporter-2 inhibitor-associated euglycemic diabetic ketoacidosis in COVID-19-infected patients: A systematic review of case reports.World journal of clinical cases · 2023Article
- Risk analysis of COVID-19 hospitalization and critical care by race and region in the United States: a cohort study.BMC public health · 2023Article
- SGLT2 inhibitors for patients with type 2 diabetes and CKD: a narrative review.Endocrine connections · 2023Review
- Review
- Diabetic ketoacidosis, COVID-19 and blood viscosity.Journal of Taibah University Medical Sciences · 2022Article
- Euglycemic diabetic ketoacidosis in pregnancy with COVID-19: A case report and literature review.Clinical case reports · 2022Article
- Euglycemic diabetic ketoacidosis associated with SGLT2 inhibitors: A systematic review and quantitative analysis.Journal of family medicine and primary care · 2022Article
- Diabetes and COVID-19; A Bidirectional Interplay.Frontiers in endocrinology · 2022Review
- COVID-19 and Diabetes.Journal of clinical medicine · 2021Review
- Article
- Diabetic ketoacidosis in patients with SARS-CoV-2: a systematic review and meta-analysis.Diabetology & metabolic syndrome · 2021Article
- The management of type 2 diabetes before, during and after Covid-19 infection: what is the evidence?Cardiovascular diabetology · 2021Article
- Early and late endocrine complications of COVID-19.Endocrine connections · 2021Review
- ECMM/ISHAM recommendations for clinical management of COVID-19 associated mucormycosis in low- and middle-income countries.Mycoses · 2021Article
- Sodium-glucose cotransporter 2 inhibitor-induced euglycaemic diabetic ketoacidosis in heart failure with preserved ejection fraction.ESC heart failure · 2021Article
- Advanced-glycation end-products axis: A contributor to the risk of severe illness from COVID-19 in diabetes patients.World journal of diabetes · 2021Review
Corrections and comments
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
Abstract
objectiveDiabetes mellitus is associated with poor outcomes in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Diabetic ketoacidosis (DKA) has also been reported to occur with this virus. A cluster of cases of euglycemic DKA (euDKA) was identified in patients with type 2 diabetes mellitus using sodium-glucose cotransporter-2 inhibitors (SGLT2is) who developed SARS-CoV-2 infection.
methodsThe cases were identified by the authors while providing clinical care, and details were collected.
resultsFive cases of euDKA, presenting with glucose levels <300 mg/dL, were identified over the course of 2 months by the endocrinology consult service. All patients had a history of type 2 diabetes mellitus with no known history of DKA. All were taking SGLT2is. Oral antihyperglycemic medications were stopped for all patients on admission. All received intravenous insulin infusion to treat DKA before being transitioned to a subcutaneous insulin regimen. SGLT2i use was discontinued for all patients who were discharged.
conclusionEuDKA has been seen in the setting of acute illness in patients using SGLT2is, but this cluster of cases suggests that there is a specific association with SARS-CoV-2 infection. In addition to the known risk of euDKA with SGLT2i use, coronavirus disease 2019-specific mechanisms may include a direct toxic effect of the virus on the pancreatic islets, an accelerated inflammatory response promoting ketosis, and the diuretic effect of SGLT2i in conjunction with anorexia and vomiting. It is crucial to counsel patients to stop SGLT2is when sick, especially if SARS-CoV-2 infection is suspected.
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