Association Between SGLT2 Inhibitor Treatment and Diabetic Ketoacidosis and Mortality in People With Type 2 Diabetes Admitted to Hospital With COVID-19.
Author
Khunti, KamleshRuan, Yue
Davies, Jim
Field, Benjamin C T
Harris, Sophie
Kosiborod, Mikhail
Nagi, Dinesh
Narendran, Parth
Patel, Dipesh
Ryder, Robert
Várnai, Kinga A
Wild, Sarah H
Wilmot, Emma G
Rea, Rustam
Affiliation
University of Leicester; Oxford National Institute for Health Research Biomedical Research Centre; Oxford University Hospitals National Health Service Foundation Trust; Sandwell and West Birmingham NHS Trust; et al.Publication date
2022-09-08Subject
Endocrinology
Metadata
Show full item recordAbstract
Objective: To determine the association between prescription of SGLT2 inhibitors (SGLT2is) and diabetic ketoacidosis (DKA) incidence or mortality in people with type 2 diabetes (T2D) hospitalized with COVID-19. Research design and methods: This was a retrospective cohort study based on secondary analysis of data from a large nationwide audit from a network of 40 centers in the U.K. with data collection up to December 2020. The study was originally designed to describe risk factors associated with adverse outcomes among people with diabetes who were admitted to hospital with COVID-19. The primary outcome for this analysis was DKA on or during hospital admission. The secondary outcome was mortality. Crude, age-sex adjusted, and multivariable logistic regression models were used to generate odds ratios (ORs) and 95% CIs for people prescribed SGLT2i compared with those not prescribed SGLT2i. Results: The original national audit included 3,067 people with T2D who were admitted to hospital with COVID-19, of whom 230 (7.5%) were prescribed SGLT2is prior to hospital admission. The mean age of the overall cohort was 72 years, 62.3% were men, and 34.9% were prescribed insulin. Overall, 2.8% of the total population had DKA and 35.6% of people in the study died. The adjusted odds of DKA were not significantly different between those prescribed SGLT2is and those not (OR 0.56; 95% CI 0.16-1.97). The adjusted odds of mortality associated with SGLT2is were similar in the total study population (OR 1.13; 95% CI 0.78-1.63), in the subgroup prescribed insulin (OR 1.02; 95% CI 0.59-1.77), and in the subgroup that developed DKA (OR 0.21; 95% CI 0.01-8.76). Conclusions: We demonstrate a low risk of DKA and high mortality rate in people with T2D admitted to hospital with COVID-19 and limited power, but no evidence, of increased risk of DKA or in-hospital mortality associated with prescription of SGLT2is.Citation
Khunti K, Ruan Y, Davies J, Field BCT, Harris S, Kosiborod M, Nagi D, Narendran P, Patel D, Ryder REJ, Várnai KA, Wild SH, Wilmot EG, Rea R; ABCD COVID-19 Diabetes National Audit Investigators. Association Between SGLT2 Inhibitor Treatment and Diabetic Ketoacidosis and Mortality in People With Type 2 Diabetes Admitted to Hospital With COVID-19. Diabetes Care. 2022 Sep 8:dc220357. doi: 10.2337/dc22-0357.Type
ArticlePMID
36074663Journal
Diabetes CarePublisher
American Diabetes Associationae974a485f413a2113503eed53cd6c53
10.2337/dc22-0357