MON-652 The Prevalence and Clinical Characteristics of Adult Patients Presenting with Sodium-Glucose Co-Transporter-2 Inhibitor Associated Euglycemic Diabetic Ketoacidosis
Bibliographic record
Abstract
Abstract Background: Sodium-Glucose Co-Transporter-2 Inhibitors (SGLT-2i) have been associated with euglycemic diabetic ketoacidosis (EuDKA). The pathophysiology is related to decrease insulin secretion given glucosuria and lower insulin to glucagon ratio, resulting in enhanced lipolysis and ketogenesis at a lower glucose level. SGLT-2i may unmask underlying undiagnosed type-1 diabetes/Latent Autoimmune Diabetes of the Adult (LADA). Objective: (1)To describe the frequency and clinical characteristics of SGLT-2i associated EuDKA at a Canadian tertiary care centre. (2)To identify the most common underlying diabetes-type associated with EuDKA. Methods: A chart review identified patients with SGLT-2i-associated EuDKA from June 2015 to May 2019 who presented to a Canadian tertiary care centre. Clinical characteristics include age, gender, diabetes type, SGLT-2i drug prescribed, laboratory results at the time of EuDKA and possible precipitants were reviewed. Pancreatic autoantibodies (anti-GAD-65, anti-islet cell, IA-2, and insulin antibodies) were measured to screen for the possibility of undiagnosed LADA. Results: Between June 2015 to May 2019, there were 647 DKA events of which 43 were related to SGLT-2i (Prevalence 6.64%). Canagliflozin was the most common SGLT-2i (53.5%) followed by Empagliflozin (34.9%). The most common precipitant was infection (16.3%), followed by surgery (14%). At presentation, average blood glucose was 14.95±12.51 mmol/L, pH 7.23±0.16, HCO3 12.86 ± 5.51 mmol/L, potassium 4.40±0.86 mmol/L and anion-gap 22.05±5.51 mmol/L. Average HbA1c was 9.2%±2.10 and BMI was 29.34±4.49. Twenty patients had pancreatic autoantibodies testing and seven were positive (35%), most commonly anti-GAD-65 (71.4%). As a result, seven patients were diagnosed with LADA who were previously diagnosed with type-2 diabetes. Out of the 7 patients with LADA, 2 had a positive family history of type-1 diabetes. Conclusion: SGLT-2i associated EuDKA could unmask underlying LADA. Further studies are warranted to determine if routine pancreatic antibodies should be drawn for diabetes typing prior to prescribing or at presentation of SGLT-2i associated EuDKA.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".