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This case series describes 8 patients with SGLT2i–associated euglycemic diabetic ketoacidosis in the setting of colonoscopy. Bowel preparation increases the risk of euglycemic diabetic ketoacidosis, whereas the colonoscopy procedure itself does not.
There is a risk of euglycemic diabetic ketoacidosis if SGLT2i are not held. The authors recommend stopping SGLT2i at least 2 days prior to colonoscopy.
This abstract is available on the publisher's site.
More than 10% of adults undergoing colonoscopy have type 2 diabetes (T2D) (1). The use of sodium–glucose cotransporter 2 inhibitors (SGLT2i) has increased due to their glycemic control and benefits of lowering cardiovascular morbidity and mortality as well as reducing diabetic nephropathy (2,3).
Diabetic ketoacidosis (DKA) is a rare complication associated with SGLT2i. Precipitating factors include fasting, dietarymodifications, intercurrent illnesses, surgical stress, insulin insufficiency, and inappropriate management of SGLT2i in the periprocedural period. SGLT2i induced ketoacidosis can present either with elevated blood glucose levels (BGL) or with near-normal BGL (<250 mg/dL), termed euglycemic diabetic ketoacidosis (EDKA) (4). Interventional gastroenterology procedures, in particular colonoscopy, pose risk for EDKA with SGLT2i use due to cathartic bowel preparation, fluid-only dietary restriction, and fasting. We present a series of cases of EDKA in the setting of colonoscopy and discuss its procedure-specific implications.