Continuous glucose monitoring - proved hypoglycemia in sodium-glucose co-transporter-2 inhibitors - treated type 2 diabetes patients: a link to ketosis development
- 作者: Levit S.1,2, Giveon S.3, Musin I.N.2, Barnea R.4, Korek-Abadi I.5, Levit V.6, Ryder D.7, Ryder C.7,8,9
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隶属关系:
- Institute of Endocrinology, Diabetes & Metabolism, Assuta Medical Center, Tel-Aviv, Israel
- National Research Technological University, Kazan, Russia
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Assuta Research Institute, Assuta Medical Center, Tel-Aviv, Israel
- Department of Academy and Research, Assuta Medical Center, Tel-Aviv, Israel.
- Department of Disease prevention, City Clinical Hospital №8, Chelyabinsk, Russia
- Virtual-Reality & Neuro Cognition Lab, Technion – Israel Institute of Technology, Haifa, Israel
- Brain Research Laboratory, Department of Neurology, Ziv Medical Center, Safed, Israel
- Faculty of Medicine, Bar-Ilan University, Safed, Israel
- 期: 卷 1, 编号 1 (2019)
- 页面: 52-69
- 栏目: Biomedical Sciences
- URL: https://journals.eco-vector.com/PharmForm/article/view/18536
- DOI: https://doi.org/10.17816/phf18536
- ID: 18536
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Background: Latest studies have shown the remarkable ability of sodium-glucose co-transporter-2 inhibitors (SGLT2i) to reduce cardiovascular morbidity and mortality. However, real-life data and the results of several other studies seem to contradict these outcomes, pointing out possibilities of serious side effects. Ketoacidosis (KA) remains one of the most dangerous complications, yet, not fully understood. All of the above urgently requires real-practice data, which may shed some light on side effects of this novel anti-diabetic drug family.
Aims: To investigate the real-life rates of hypoglycemia and ketosis (K) in SGLT2i treated patients, using Continuous Glucose Monitoring (CGM) and capillary blood β-hydroxybutyrate measurements.
Methods: We report the results of a two-year retrospective analysis of 136 Type 2 Diabetes (T2DM) patients, all (100%) treated with a SGLT2i, combined with Metformin or Metformin with Incretin-Based therapy (MT-IBT). CGM recordings were done in 52 persons. In 9 patients (Group A), CGM-proved hypoglycemic episodes were discovered. The rest of 43 patients (Group B) didn’t show any hypoglycemia. Three patients in Group A and 11 from Group B were also treated with small doses of basal insulin on admission; the insulin was later discontinued in all patients of Group A and seven patients of Group B . Main characteristics of two groups were subsequently compared.
Results: CGM data analysis showed significantly lower average Sensor Glucose (SG) , 7.2±1.3 vs. 8.2±1.7 mmol/l, p=0.04, and estimated HbA1c , 6.1±0.7 vs. 6.8±1.1%, p=0.02, in Group A patients.
We also report three cases of ketosis, proved by elevated capillary β-hydroxybutyrate concentrations. Pathophysiological link between frequent hypoglycemia rates (Six patients without insulin treatment (11.5 % in total CGM group of 52 patients)) and ketosis development (Three patients (2.2% in total cohort of 136 participants)) was suggested.
Conclusions: More frequent than previously reported rates of hypoglycemia and ketoacidosis were discovered in patients taking SGLT2 inhibitors. Pathophysiological link between the two conditions is assumed. More studies are needed to confirm our hypothesis.
作者简介
Shmuel Levit
Institute of Endocrinology, Diabetes & Metabolism, Assuta Medical Center, Tel-Aviv, Israel;National Research Technological University, Kazan, Russia
编辑信件的主要联系方式.
Email: shmuelle@assuta.co.il
ORCID iD: 0000-0003-0406-8021
MD, PhD, Professor, Head of Institute of Endocrinology, Diabetes & Metabolism, Assuta Medical Center; Professor of Kazan National Research Technological University, Russian Federation
以色列, Street, Tel-Aviv 6971028, Israel; st. Karl Marx, 68, Kazan, Republic of Tatarstan, 420015, RussiaShmuel Giveon
Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Email: giveon@clalit.org.il
ORCID iD: 0000-0002-3638-0055
Doctor of Medical Sciences, Master of Health, Head of Research
以色列, Tel-Aviv, IsraelIldar Musin
National Research Technological University, Kazan, Russia
Email: ildarmusin@mail.ru
ORCID iD: 0000-0003-4516-4183
PhD. of Engineering Science, Head of the Department of medical Informatics
以色列, Karl Marx str., 68, Kazan, Republic of Tatarstan, 420015, RussiaRoyi Barnea
Assuta Research Institute, Assuta Medical Center, Tel-Aviv, Israel
Email: royib@assuta.co.il
ORCID iD: 0000-0002-6119-9725
PhD, Chief investigator, Assuta Health Services Research Institute, Assuta Medical Centers Network
以色列, street Habarzel 20. Tel-Aviv 6971028, IsraelIfat Korek-Abadi
Department of Academy and Research, Assuta Medical Center, Tel-Aviv, Israel.
Email: ifata@assuta.co.il
ORCID iD: 0000-0002-2771-8819
PhD, Academic and research director, Department of Academy and Research, Assuta Medical Center, Assuta Medical Centers Network
以色列, street Habarzel 20. The 6971028 Tel Aviv, IsraelVyacheslav Levit
Department of Disease prevention, City Clinical Hospital №8, Chelyabinsk, Russia
Email: slava_levit@mail.ru
ORCID iD: 0000-0003-1306-1374
MD, Head of Disease Prevention Department
俄罗斯联邦, Chelyabinsk, Gorky street, 18Darian Ryder
Virtual-Reality & Neuro Cognition Lab, Technion – Israel Institute of Technology, Haifa, Israel
Email: Darian@Neurologit.com
ORCID iD: 0000-0001-9691-7136
PhD
以色列, Haifa, 3200003Chen Hanna Ryder
Virtual-Reality & Neuro Cognition Lab, Technion – Israel Institute of Technology, Haifa, Israel;Brain Research Laboratory, Department of Neurology, Ziv Medical Center, Safed, Israel;
Faculty of Medicine, Bar-Ilan University, Safed, Israel
Email: chen.r@ziv.health.gov.il
ORCID iD: 0000-0002-9028-1154
PhD, Principal Investigator, Head of the Brain Research Laboratory, Department of Neurology, Ziv Medical Center
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