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Case Reports
. 2023 Jan;33(1):339-344.
doi: 10.1007/s11695-022-06368-3. Epub 2022 Nov 24.

Sodium-Glucose Co-transporter-2 Inhibitors Induced Diabetic Ketoacidosis in Patients Undergoing Bariatric Surgery: a Systematic Review of Case Reports and Case Series

Nakul Gokhare Viswanath  1 , Mitesh Sharma  2 , Nanda Bandlamudi  3 , Iskandar Idris  4 , Rishi Singhal  5 , Kamal Mahawar  6 , Brijesh Madhok  3
Affiliations
Case Reports

Sodium-Glucose Co-transporter-2 Inhibitors Induced Diabetic Ketoacidosis in Patients Undergoing Bariatric Surgery: a Systematic Review of Case Reports and Case Series

Nakul Gokhare Viswanath et al. Obes Surg. 2023 Jan.

Abstract

Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are glucose-lowering agents being increasingly used for cardio-renal protection in patients with or without type 2 diabetes (T2DM). This systematic review identified the clinical risk factors and outcomes of diabetic ketoacidosis (DKA) in patients undergoing bariatric and metabolic surgery (BMS) on SGLT2i. We found 12 studies with a total of 16 patients (10 females; mean age of 51 years). Apart from one patient, all patients developed DKA in the post-operative period presenting at a median of 5 days after surgery. Most of the patients were euglycaemic on presentation with DKA. Patients undergoing BMS on SGLT2i are at increased risk of developing DKA that can mimic post-operative surgical complications causing diagnostic dilemmas, especially with the euglycaemic variant, and delaying treatment.

Keywords: Bariatric and metabolic surgery; Diabetic ketoacidosis; Euglycaemic; Sodium-glucose co-transport 2 inhibitors.

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