PDF(Pubmed)
Abstract：
BACKGROUND: Diabetic ketoacidosis (DKA) manifests as hyperglycemia, metabolic acidosis, and ketosis. However, euglycemic DKA (eu-DKA) conceals severe DKA with glucose levels below 200 mg/dL. Sodium-glucose cotransporter-2 (SGLT2) inhibitors can induce eu-DKA in diabetic patients. Notably, coronavirus disease 2019 (COVID-19) -infected individuals with diabetes using SGLT2 inhibitors face an augmented risk of eu-DKA due to the direct toxic impact of the virus on pancreatic islets. This study aims to comprehensively investigate the association between SGLT2 inhibitors and eu-DKA in COVID-19 patients through meticulous case report analysis. Additionally, we endeavor to examine the outcomes and treatment approaches for COVID-19-infected diabetics receiving SGLT2 inhibitors, providing indispensable insights for healthcare professionals managing this specific patient population.
OBJECTIVE: To investigate the connection between SGLT2 inhibitors and euglycemic DKA in COVID-19 patients through a meticulous analysis of case reports.
METHODS: We conducted an exhaustive search across prominent electronic databases, including PubMed, SCOPUS, Web of Science, and Google Scholar. This search encompassed the period from December 2019 to May 2022, incorporating published studies and pre-prints. The search terms employed encompassed \"SGLT2 inhibitors\", \"euglycemic DKA\", \"COVID-19\", and related variations. By incorporating these diverse sources, our objective was to ensure a thorough exploration of the existing literature on this subject, thereby augmenting the validity and robustness of our findings.
RESULTS: Our search yielded a total of seven case reports and one case series, collectively comprising a cohort of twelve patients. These reports detailed instances of eu-DKA in individuals with COVID-19. Crucially, all twelve patients were utilizing SGLT2 as their primary anti-diabetic medication. Upon admission, all oral medications were promptly discontinued, and the patients were initiated on intravenous insulin therapy to effectively manage the DKA. Encouragingly, eleven patients demonstrated a favorable outcome, while regrettably, one patient succumbed to the condition. Subsequently, SGLT2 were discontinued for all patients upon their discharge from the hospital. These findings provide valuable insights into the clinical management and outcomes of eu-DKA cases associated with COVID-19 and SGLT2, underscoring the critical importance of prompt intervention and vigilant medication adjustments.
CONCLUSIONS: Our study sheds light on the possibility of diabetic patients developing both drug-related and unrelated DKA, as well as encountering adverse outcomes in the context of COVID-19, despite maintaining satisfactory glycemic control. The relationship between glycemic control and clinical outcomes in COVID-19 remains ambiguous. Consequently, this systematic review proposes that COVID-19-infected diabetic patients using SGLT2 should contemplate alternative treatment protocols until their recovery from the disease.
OBJECTIVE: To investigate the connection between SGLT2 inhibitors and euglycemic DKA in COVID-19 patients through a meticulous analysis of case reports.
METHODS: We conducted an exhaustive search across prominent electronic databases, including PubMed, SCOPUS, Web of Science, and Google Scholar. This search encompassed the period from December 2019 to May 2022, incorporating published studies and pre-prints. The search terms employed encompassed \"SGLT2 inhibitors\", \"euglycemic DKA\", \"COVID-19\", and related variations. By incorporating these diverse sources, our objective was to ensure a thorough exploration of the existing literature on this subject, thereby augmenting the validity and robustness of our findings.
RESULTS: Our search yielded a total of seven case reports and one case series, collectively comprising a cohort of twelve patients. These reports detailed instances of eu-DKA in individuals with COVID-19. Crucially, all twelve patients were utilizing SGLT2 as their primary anti-diabetic medication. Upon admission, all oral medications were promptly discontinued, and the patients were initiated on intravenous insulin therapy to effectively manage the DKA. Encouragingly, eleven patients demonstrated a favorable outcome, while regrettably, one patient succumbed to the condition. Subsequently, SGLT2 were discontinued for all patients upon their discharge from the hospital. These findings provide valuable insights into the clinical management and outcomes of eu-DKA cases associated with COVID-19 and SGLT2, underscoring the critical importance of prompt intervention and vigilant medication adjustments.
CONCLUSIONS: Our study sheds light on the possibility of diabetic patients developing both drug-related and unrelated DKA, as well as encountering adverse outcomes in the context of COVID-19, despite maintaining satisfactory glycemic control. The relationship between glycemic control and clinical outcomes in COVID-19 remains ambiguous. Consequently, this systematic review proposes that COVID-19-infected diabetic patients using SGLT2 should contemplate alternative treatment protocols until their recovery from the disease.
摘要：
背景：糖尿病酮症酸中毒（DKA）表现为高血糖，代谢性酸中毒,和酮症。然而,正常血糖DKA（eu-DKA）隐藏血糖水平低于200mg/dL的严重DKA。钠-葡萄糖协同转运蛋白-2(SGLT2)抑制剂可在糖尿病患者中诱导eu-DKA。值得注意的是,2019年冠状病毒病（COVID-19）感染的使用SGLT2抑制剂的糖尿病患者由于病毒对胰岛的直接毒性影响，面临欧盟DKA的风险增加。本研究旨在通过细致的病例报告分析，全面探讨SGLT2抑制剂与eu-DKA在COVID-19患者中的相关性。此外,我们努力检查接受SGLT2抑制剂的COVID-19感染的糖尿病患者的结局和治疗方法，为管理这一特定患者人群的医疗保健专业人员提供不可或缺的见解。
目的：通过对病例报告的细致分析，探讨SGLT2抑制剂与COVID-19患者正常血糖DKA的关系。
方法：我们在著名的电子数据库中进行了详尽的搜索，包括PubMed,Scopus,WebofScience,谷歌学者。此次搜索涵盖了2019年12月至2022年5月的期间，纳入了已发表的研究和预印本。使用的搜索术语包括“SGLT2抑制剂”，“正常血糖DKA”，“COVID-19”，和相关的变化。通过整合这些不同的来源，我们的目标是确保对有关此主题的现有文献进行彻底探索，从而增强我们研究结果的有效性和稳健性。
结果：我们的搜索共产生了7个病例报告和1个病例系列，总共包括12名患者的队列。这些报告了COVID-19患者中欧盟DKA的详细实例。至关重要的是，所有12例患者均使用SGLT2作为其主要的抗糖尿病药物.一被录取,所有口服药物都及时停药，患者开始静脉胰岛素治疗以有效管理DKA.令人鼓舞的是，11名患者表现出良好的结果，遗憾的是,一名病人死于这种情况。随后，所有患者出院后停止SGLT2。这些发现为与COVID-19和SGLT2相关的eu-DKA病例的临床管理和结果提供了有价值的见解，强调了及时干预和警惕药物调整的至关重要性。
结论：我们的研究揭示了糖尿病患者发生药物相关和无关DKA的可能性，以及在COVID-19的背景下遇到不良结局，尽管血糖控制保持令人满意。COVID-19的血糖控制与临床结局之间的关系仍然不明确。因此,这项系统评价提出,使用SGLT2的COVID-19感染的糖尿病患者应考虑替代治疗方案,直至其疾病康复.
目的：通过对病例报告的细致分析，探讨SGLT2抑制剂与COVID-19患者正常血糖DKA的关系。
方法：我们在著名的电子数据库中进行了详尽的搜索，包括PubMed,Scopus,WebofScience,谷歌学者。此次搜索涵盖了2019年12月至2022年5月的期间，纳入了已发表的研究和预印本。使用的搜索术语包括“SGLT2抑制剂”，“正常血糖DKA”，“COVID-19”，和相关的变化。通过整合这些不同的来源，我们的目标是确保对有关此主题的现有文献进行彻底探索，从而增强我们研究结果的有效性和稳健性。
结果：我们的搜索共产生了7个病例报告和1个病例系列，总共包括12名患者的队列。这些报告了COVID-19患者中欧盟DKA的详细实例。至关重要的是，所有12例患者均使用SGLT2作为其主要的抗糖尿病药物.一被录取,所有口服药物都及时停药，患者开始静脉胰岛素治疗以有效管理DKA.令人鼓舞的是，11名患者表现出良好的结果，遗憾的是,一名病人死于这种情况。随后，所有患者出院后停止SGLT2。这些发现为与COVID-19和SGLT2相关的eu-DKA病例的临床管理和结果提供了有价值的见解，强调了及时干预和警惕药物调整的至关重要性。
结论：我们的研究揭示了糖尿病患者发生药物相关和无关DKA的可能性，以及在COVID-19的背景下遇到不良结局，尽管血糖控制保持令人满意。COVID-19的血糖控制与临床结局之间的关系仍然不明确。因此,这项系统评价提出,使用SGLT2的COVID-19感染的糖尿病患者应考虑替代治疗方案,直至其疾病康复.
