A class of drugs commonly prescribed to manage type 2 diabetes may increase the risk of ketoacidosis, a potentially life-threatening condition known as a 'diabetic attack,' according to new research. The study, published in The Lancet Diabetes and Endocrinology journal, identifies SGLT2 inhibitors as a potential trigger for this condition, where harmful ketone levels build up in the blood.
Scientists at Sweden's Karolinska Institute analyzed the health records of 280,000 individuals with type 2 diabetes who were treated with SGLT2 inhibitors. These medications, which include brands like Forxiga, Invokana, Jardiance, and Steglatro, help lower blood sugar by increasing sugar excretion through the kidneys.
While SGLT2 inhibitors are widely used and offer benefits such as protecting against heart and kidney disease and aiding in weight loss, the study suggests that certain patients are at a higher risk of developing ketoacidosis. This risk appears to be elevated in individuals with a history of the condition, high blood sugar levels, underweight status, or signs of malnutrition. A history of dangerously low blood sugar, or hypoglycemia, also increased the risk.
Infections were identified as the most frequent trigger for ketoacidosis among patients. Other contributing factors included kidney problems, stroke, and major surgery. The researchers noted that while the risk was highest in the initial months of treatment, it persisted throughout the duration of medication use.
Experts previously hypothesized that these drugs promote the body's fat-burning process for energy, which can lead to increased ketone production. This new warning comes amid separate research indicating a rise in ketoacidosis-related deaths in the United Kingdom.
"SGLT2 inhibitors provide medical benefits for many patients," said Peter Ueda, assistant professor at the Karolinska Institute's Department of Medicine. "Our findings are not primarily about avoiding treatment, but about improving our ability to identify high-risk patients and use these medicines more safely."
The researchers aim for their findings to assist clinicians in determining when to potentially discontinue treatment. They also plan to investigate other rare but serious side effects associated with modern diabetes medications.
Symptoms of ketoacidosis can include excessive thirst, increased urination, stomach pain, nausea, vomiting, diarrhea, and blurred vision. Other warning signs include unusually deep breathing, a fruity odor on the breath, and feelings of extreme tiredness, sleepiness, or confusion.