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Sodium–glucose cotransporter type 2 inhibitors: managing the small but critical risk of diabetic ketoacidosis

Emily J Meyer, Venkatesan Thiruvenkatarajan and David Jesudason
Med J Aust 2021; 214 (2): . || doi: 10.5694/mja2.50899
Published online: 1 February 2021

To the Editor: We would like to highlight some points arising from the discussion by Hamblin and colleagues regarding euglycaemic diabetic ketoacidosis associated with sodium–glucose cotransporter type 2 (SGLT2) inhibitors.1


  • 1 The Queen Elizabeth Hospital, Adelaide, SA
  • 2 University of Adelaide, Adelaide, SA


Correspondence: david.jesudason@sa.gov.au

Competing interests:

No relevant disclosures.

  • 1. Hamblin PS, Wong R, Bach LA. Sodium–glucose cotransporter type 2 inhibitors: managing the small but critical risk of diabetic ketoacidosis. Med J Aust 2020; 212: 294–296. https://www.mja.com.au/journal/2020/212/7/sodium-glucose-cotransporter-type-2-inhibitors-managing-small-critical-risk
  • 2. Thiruvenkatarajan V, Meyer EJ, Nanjappa N, et al. Perioperative diabetic ketoacidosis associated with sodium‐glucose co‐transporter‐2 inhibitors: a systematic review. Br J Anaesth 2019; 123: 27–36.
  • 3. Thiruvenkatarajan V, Nanjappa N, Sembu M, et al. An analysis of the Australian Therapeutic Goods Administration Database of Adverse Event Notifications of diabetic ketoacidosis associated with sodium–glucose cotransporter‐2 inhibitors in surgical patients. Anaesth Intensive Care 2020; 48: 70–72.
  • 4. Peters AL, Buschur EO, Buse JB, et al. Euglycemic diabetic ketoacidosis: a potential complication of treatment with sodium‐glucose cotransporter 2 inhibition. Diabetes Care 2015; 38: 1687–1693.
  • 5. Australian Diabetes Society. Alert update: periprocedural diabetic ketoacidosis (DKA) with SGLT2 inhibitor use. January 2020. http://diabetessociety.com.au/documents/ADS_DKA_SGLT2i_Alert_update_2020.pdf (viewed Nov 2020).
  • 6. Meyer EJ, Thiruvenkatarajan V, Jesudason D. Periprocedural euglycemic diabetic ketoacidosis associated with sodium–glucose cotransporter 2 inhibitor therapy during colonoscopy. Diabetes Care 2020; 43: e181–e184.

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