背景:钠-葡萄糖协同转运蛋白2抑制剂是一类新型的抗高血糖药物。尽管一些围手术期正常血糖糖尿病酮症酸中毒病例与这些药物有关,该协会仍不清楚。本研究旨在研究钠-葡萄糖协同转运蛋白2抑制剂使用与围手术期代谢性酸中毒伴血糖正常的发生率之间的关系。围手术期正常血糖糖尿病酮症酸中毒的替代结局。
方法:这是一个回顾性研究,配对队列研究,这是在日本三级护理机构的重症监护室进行的。我们确定了年龄在20岁或以上的糖尿病患者,这些患者接受了药物治疗,并在2014年4月至2019年3月期间接受了择期手术后进入重症监护病房。我们从电子病历中提取以下数据进行匹配:年龄,性别,手术年,手术部位,血红蛋白A1c水平,和钠-葡萄糖协同转运蛋白2抑制剂的处方。符合条件的患者分为两组,服用钠-葡萄糖协同转运蛋白2抑制剂的患者(SGLT2-i组)和未服用钠-葡萄糖协同转运蛋白2抑制剂的患者(对照组).对于SGLT2-i组中的每位患者,我们从对照组中随机选择4例与提取的特征相匹配的患者.主要结果是代谢性酸中毒的发生率,阴离子间隙升高和血糖正常。次要结果是每位患者在ICU住院期间的最低pH值。
结果:本研究共纳入155例患者。接受钠-葡萄糖协同转运蛋白2抑制剂的患者具有与对照参与者相当的特征;然而,接受透析的患者比例不相似.在接受钠-葡萄糖协同转运蛋白2抑制剂的7/31(22.6%)患者和10/124(8.1%)对照患者(p=0.047)中发现了伴有血糖正常的代谢性酸中毒。
结论:这项研究表明,使用钠-葡萄糖协同转运蛋白2抑制剂与血糖正常的代谢性酸中毒的发生率显着升高有关。接受钠-葡萄糖协同转运蛋白2抑制剂计划接受侵入性外科手术的患者应密切监测正常血糖糖尿病酮症酸中毒的发展。
BACKGROUND: Sodium-glucose cotransporter 2 inhibitors are a novel class of anti-hyperglycemic agents. Although several cases of perioperative euglycemic diabetic ketoacidosis have been linked to these medications, the association remains unclear. This
study aimed to examine the association between sodium-glucose cotransporter 2 inhibitor use and the incidence of perioperative metabolic acidosis with euglycemia, the surrogating outcome of perioperative euglycemic diabetic ketoacidosis.
METHODS: This was a retrospective, matched cohort
study, which was conducted in the intensive care unit of a tertiary care facility in Japan. We identified patients aged 20 years or older with diabetes mellitus who received pharmacologic therapy and were admitted to the intensive care unit after elective surgery between April 2014 and March 2019. We extracted the following data from the electronic medical record for matching: age, sex, surgery year, surgical site, hemoglobin A1c level, and prescription for sodium-glucose cotransporter 2 inhibitors. Eligible patients were divided into two groups, those who were prescribed sodium-glucose cotransporter 2 inhibitors (SGLT2-i group) and those who were not (control group). For each patient in the SGLT2-i group, we randomly selected four patients from the control group matched for the extracted characteristics. The primary outcome was the incidence of metabolic acidosis with an elevated anion gap and euglycemia. The secondary outcome was the lowest pH value of each patient during their ICU stay.
RESULTS: A total of 155 patients were included in this
study. Patients receiving sodium-glucose cotransporter 2 inhibitors had comparable characteristics to control participants; however, the proportions of patients undergoing dialysis were not similar. Metabolic acidosis with euglycemia was seen in 7/31 (22.6%) patients receiving sodium-glucose cotransporter 2 inhibitors and in 10/124 (8.1%) control patients (p = 0.047).
CONCLUSIONS: This
study shows that the use of sodium-glucose cotransporter 2 inhibitors is associated with a significantly higher incidence of metabolic acidosis with euglycemia. Patients receiving sodium-glucose cotransporter 2 inhibitors who are scheduled to undergo invasive surgical procedures should be closely monitored for the development of euglycemic diabetic ketoacidosis.