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Type 1 diabetes pilot8/3/2023 ![]() ![]() Given the above concerns and lack of data in the ICU setting, we conducted a pilot case–control study in ICU patients with type 2 diabetes receiving insulin aiming to evaluate whether the potential to reduce insulin requirements using the SGLT2 inhibitor empagliflozin outweighed the risk of ketoacidosis. ![]() However, reduced insulin delivery could result in relative insulin deficiency and ketoacidosis. Adding SGLT2 inhibitors has the potential to reduce insulin requirements. Previous studies suggest that large glucose fluctuations and hypoglycemia provide mechanistic links between insulin therapy and adverse clinical outcomes. Unfortunately, insulin therapy increases the risk of excessive glucose fluctuations and hypoglycemia, and these risks are exacerbated in critically ill patients with diabetes. ICU patients with type 2 diabetes experience acute-on-chronic insulin resistance, and typically require high insulin doses to achieve target blood glucose levels. Although differences were not statistically significant, these data suggest that SGLT2 inhibitors may be safely used in acutely ill patients. On the other hand, in non-critically ill patients with cardiometabolic risk factors who were hospitalized with COVID-19, dapagliflozin therapy resulted in a numerical reduction in organ failure, including acute kidney injury, renal replacement therapy and death within 30 days compared with placebo. Concerns include observed associations between SGLT2 inhibitors and increased risk of normoglycemic ketoacidosis, urinary tract infections, electrolyte and acid–base disturbances, and early decline in glomerular filtration rate triggered by tubuloglomerular activation and decreased intraglomerular pressure. However, the safety and efficacy of SGLT2 inhibitors in critically ill patients treated in the intensive care unit (ICU) has never been assessed. In addition, in patients with chronic kidney disease and marked albuminuria, treatment with the SGLT2 inhibitor dapagliflozin also reduced the risk of abrupt declines in kidney function as defined by a doubling of serum creatinine between two subsequent study visits (median time-interval 100 days). In our pilot study of ICU patients with type 2 diabetes, empagliflozin therapy was associated with increases in sodium and chloride levels but was not significantly associated with acid–base changes, hypoglycemia, ketoacidosis, worsening kidney function, bacteriuria, or mortality.ĭata from large randomized controlled trials have shown that sodium glucose co-transporter-2 (SGLT2) inhibitors attenuate cardiovascular and kidney disease progression regardless of the presence or absence of diabetes. Overall, 17% of treatment group patients and 19% of control group patients died in hospital ( P = 0.79). Urine cultures were positive in 22% of treatment group patients and 13% of control group patients ( P = 0.28). ![]() Worsening kidney function occurred in 18% and 29% of treatment and control group patients, respectively ( P = 0.54). No patient in the treatment group and one patient in the control group developed ketoacidosis. Overall, 6% developed hypoglycemia in each group. We observed no differences in strong ion difference, pH or base excess. Median (IQR) maximum increase in sodium and chloride levels were 3 (1–10) mmol/l and 3 (2–8) mmol/l in the control group and 9 (3–12) mmol/l and 8 (3–10) mmol/l in the treatment group ( P = 0.045 for sodium, P = 0.059 for chloride). We compared changes in electrolyte and acid–base parameters, hypoglycemia, ketoacidosis, worsening kidney function, urine culture findings, and hospital mortality between the groups. Treatment group patients were matched on age, glycated hemoglobin A1c, and ICU duration with 72 ICU patients with type 2 diabetes exposed to the same target glucose range but who did not receive empagliflozin (control group). We included 18 ICU patients with type 2 diabetes receiving empagliflozin (10 mg daily) and insulin to target glucose range of 10–14 mmol/l according to our liberal glucose control protocol for patients with diabetes (treatment group). We aimed to perform a pilot study to assess the relationship between empagliflozin therapy and biochemical, and clinical outcomes in such patients. However, the safety of SGLT2 inhibitors in ICU patients with type 2 diabetes is uncertain. Sodium glucose co-transporter-2 (SGLT2) inhibitors improve long-term cardiovascular and renal outcomes in individuals with type 2 diabetes. ![]()
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