钠-葡萄糖协同转运蛋白2抑制剂(SGLT2i)在结肠镜检查时与糖尿病酮症酸中毒有关。本研究旨在确定SGLT2i治疗的2型糖尿病与非SGLT2i治疗的糖尿病相比与酮浓度相关的因素。以及空腹血糖受损(IFG)和血糖正常的患者。
横截面,多中心,2020年6月至12月在澳大利亚四家三级医院进行的观察性研究。
在接受结肠镜检查的患者中测量了毛细血管葡萄糖和酮:37例SGLT2i治疗和105例非SGLT2i治疗的2型糖尿病,65IFG和151血糖正常。
身体质量指数(BMI),年龄,葡萄糖,禁食持续时间和相关情况下,HbA1c和自上次SGLT2i剂量以来的时间。
在SGLT2i治疗的糖尿病中,BMI(ρ=-0.43[95%置信区间:-0.67,-0.11])和自上次SGLT2i剂量以来的持续时间(ρ=-0.33[-0.60,0.00])与酮的增加呈负相关,但与禁食时间无关。在非SGLT2i治疗的糖尿病中,BMI与酮呈负相关(ρ=-0.24[-0.42,-0.05])和空腹持续时间呈正相关(ρ=0.26[0.07,0.43])。在IFG参与者中,仅禁食持续时间与酮相关(ρ=0.28[0.03,0.49])。在血糖正常的参与者中,与BMI(ρ=-0.20[-0.35,-0.04])和空腹血糖(ρ=-0.31[-0.45,-0.15])呈负相关,与空腹持续时间(ρ=0.20[0.04,0.35])和年龄(ρ=0.19[0.03,0.34])呈正相关。整个队列的多元回归分析显示BMI,年龄和空腹血糖仍然与酮独立相关,但在SGLT2i治疗的参与者中,仅BMI保持独立相关.
在SGLT2i治疗的糖尿病中,较低的BMI是高酮体结肠镜检查的新危险因素.在进行更大规模的验证性研究之前,这些患者需要对酮症酸中毒格外警惕.
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been associated with diabetic ketoacidosis at the time of colonoscopy. This study aimed to identify factors associated with ketone concentrations in SGLT2i-treated type 2 diabetes compared with non-SGLT2i-treated diabetes, and those with impaired fasting glycaemia (IFG) and normoglycaemia.
Cross-sectional, multicentre, observational study June-December 2020 in four Australian tertiary hospitals.
Capillary glucose and ketones were measured in people undergoing colonoscopy: 37 SGLT2i-treated and 105 non-SGLT2i-treated type 2 diabetes, 65 IFG and 151 normoglycaemia.
Body mass index (BMI), age, glucose, fasting duration and where relevant, HbA1c and time since last SGLT2i dose.
In SGLT2i-treated diabetes, BMI (ρ = -0.43 [95% confidence interval: -0.67, -0.11]) and duration since last SGLT2i dose (ρ = -0.33 [-0.60, 0.00]) correlated negatively with increasing ketones, but there was no correlation with fasting duration. In non-SGLT2i-treated diabetes, BMI correlated negatively (ρ = -0.24 [-0.42, -0.05]) and fasting duration positively (ρ = 0.26 [0.07, 0.43]) with ketones. In IFG participants, only fasting duration correlated with ketones (ρ = 0.28 [0.03, 0.49]). In normoglycaemic participants, there were negative correlations with BMI (ρ = -0.20 [-0.35, -0.04]) and fasting glucose (ρ = -0.31 [-0.45, -0.15]) and positive correlations with fasting duration (ρ = 0.20 [0.04, 0.35]) and age (ρ = 0.19 [0.03, 0.34]). Multiple regression analysis of the entire cohort showed BMI, age and fasting glucose remained independently associated with ketones, but in SGLT2i-treated participants only BMI remained independently associated.
In SGLT2i-treated diabetes, lower BMI was a novel risk factor for higher ketones precolonoscopy. Pending larger confirmatory studies, extra vigilance for ketoacidosis is warranted in these people.