Risk of diabetic ketoacidosis associated with sodium-glucose cotransporter-2 inhibitors

HSA would like to alert healthcare professionals that sodium-glucose cotransporter-2 (SGLT2) inhibitors have been associated with the potential risk of developing diabetic ketoacidosis (DKA), some of which are euglycaemic DKA.  HSA has assessed the benefit-risk profile of SGLT2 inhibitors and found that while it remains favourable for their approved indications, the possibility of SGLT2 inhibitors use leading to an increased risk of DKA cannot be excluded, particularly in the presence of predisposing factors. Healthcare professionals are advised to use SGLT2 inhibitors according to the licensed indications and be cautious with their use in patients with predisposing factors to DKA. Patients on SGLT2 inhibitors who present with metabolic acidosis should be assessed for ketoacidosis and tested for blood ketones, even when their blood glucose levels are not high. Please refer to the Dear Healthcare Professional Letter for more details.