title: Diabetic ketoacidosis, sodium glucose transporter-2 inhibitors and the kidney.
abstract: Diabetic ketoacidosis is a serious metabolic condition that may occur in patients with either Type 1 or Type 2 diabetes. The accumulation of ketoacids in the serum is a consequence of insulin deficiency and glucagon excess. Sodium Glucose Transporter 2 (SGLT2) inhibitors are novel therapeutic treatments for improving glucose homeostasis in patients with diabetes. Through reductions in glucose reabsorption by the kidney, they lower serum glucose in patients with Type 2 diabetes and they improve glucose control whether used alone or in combination with other therapies. Mechanistically, these drugs increase serum ketoacids and increase glucagon production, which in some individuals, can lead to formation of diabetic ketoacidosis. This review will first focus in how the kidney normally handles ketoacids, and second will discuss how the SGLT2 inhibitors affect the kidney in such a way so as to enhance the risk for development of ketoacidosis in susceptible individuals.
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Biff F
authors.initials: BF
authors.lastname: Palmer
authors.affiliation: Biomedical Research Department, Diabetes and Obesity Research Division, Cedars-Sinai Medical Center, Beverly Hills, California.
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Clegg
authors.affiliation: Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Simeon I
authors.initials: SI
authors.lastname: Taylor
authors.affiliation: Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD. Electronic address: mweir@medicine.umaryland.edu.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Weir
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D016883:Diabetic Ketoacidosis / Q000139:chemically induced*; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D007668:Kidney / Q000503:physiopathology; D000077203:Sodium-Glucose Transporter 2 Inhibitors
chemical_list: D007004:Hypoglycemic Agents; D000077203:Sodium-Glucose Transporter 2 Inhibitors
keywords: Diabetic ketoacidosis; Glucose; Kidney; Sodium glucose transporter 2 inhibitors; Transport maximum