Insights into the Recognition and Management of SGLT2-Inhibitor-Associated Ketoacidosis: It's Not Just Euglycemic Diabetic Ketoacidosis.

Sodium glucose cotransporter 2 inhibitors (SGLT2i) are a new class of agents for treatment of type 2 diabetes. Their primary action is to promote glucosuria by blocking glucose reabsorption at the proximal tubule. Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada recommend SGLT2i use in patients with clinical cardiovascular disease as add-on therapy if glycemic targets are not met ( 1 Harper W. Clement M. Goldenberg R. et al. Policies, guidelines and consensus statements: Pharmacologic management of type 2 diabetes, 2015 interim update. Can J Diabetes. 2015; 39: 250-252 Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar ). This recommendation is based largely on the Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes (EMPA-REG OUTCOME) trial, which showed cardiovascular benefit in the empagliflozin arm ( 2 Zinman B. Wanner C. Lachin J.M. et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015; 373: 2117-2128 Crossref PubMed Scopus (7198) Google Scholar ). This will likely lead to increased prescribing of SGLT2i.