Published online Aug 26, 2023. doi: 10.12998/wjcc.v11.i24.5700
Peer-review started: May 29, 2023
First decision: June 19, 2023
Revised: July 13, 2023
Accepted: July 28, 2023
Article in press: July 28, 2023
Published online: August 26, 2023
Processing time: 87 Days and 17.5 Hours
The coexistence of coronavirus disease 2019 (COVID-19) infection and the use of sodium-glucose cotransporter-2 (SGLT2) inhibitors have generated debate due to the potential risk of euglycemic diabetic ketoacidosis (eu-DKA) development. Limited information regarding this specific patient population is available, necessitating a systematic review to investigate the outcomes and characteristics associated with eu-DKA in COVID-19-infected diabetic patients treated with SGLT2 inhibitors.
Given the controversy and limited data surrounding the association between SGLT2 inhibitors, COVID-19 infection, and eu-DKA, there is a pressing need to investigate this topic to enhance our understanding of the potential risks and outcomes.
The primary objectives of this study are to examine the association between SGLT2 inhibitors and the development of eu-DKA in COVID-19-infected diabetic patients, explore the potential mechanisms underlying this relationship, and assess the clinical outcomes and management strategies for this patient population.
We conducted a comprehensive search of relevant databases to identify studies reporting on the association between SGLT2 inhibitors and eu-DKA in COVID-19-infected diabetic patients. We followed the PRISMA guidelines for study selection and data extraction. The extracted data were qualitatively synthesized to provide a narrative overview of the findings.
The systematic review included eight studies comprising 12 patients, investigating the association between SGLT2 inhibitors and eu-DKA in COVID-19-infected diabetic patients. The majority of patients presented with eu-DKA symptoms 2-3 d after the onset of COVID-19 symptoms. The survival rate was over 90%, with one reported fatality. Significant pH deviations were observed, with the lowest reported pH being 6.87. All patients discontinued SGLT2 inhibitors and received treatment with fluids and IV insulin. The results highlight the potential risk of developing eu-DKA in this patient population.
This systematic review concludes that the use of SGLT2 inhibitors in COVID-19-infected diabetic patients may increase the risk of eu-DKA. The pancreatic toxicity induced by the severe acute respiratory syndrome coronavirus 2 virus is believed to contribute to this phenomenon. The analysis of case reports provides evidence supporting the association between SGLT2 inhibitors and eu-DKA in this patient population. Further studies with larger sample sizes and robust designs are necessary to enhance our understanding and inform clinical decision-making for high-risk individuals.
Further research is needed to investigate the mechanisms of eu-DKA in COVID-19 patients on SGLT2 inhibitors. Larger randomized studies are necessary to establish a causal relationship and identify risk factors. Standardized protocols for diagnosis and management should be developed to improve patient outcomes. These research perspectives will enhance understanding and guide evidence-based approaches in the future.