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Zhao Q, Tan Y, Wu Q, Xiao X, Wei X, Nian M, Yao J, Fan N, Wang R, Fan G. The risk factors of diabetic ketosis and diabetic ketoacidosis among patients with type 2 diabetes mellitus treated with SGLT2 inhibitors: a retrospective study. Expert Opin Drug Saf 2024; 23:57-65. [PMID: 37947121 DOI: 10.1080/14740338.2023.2275704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/19/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND There is limited evidence on the safety of sodium-glucose co-transporter-2 inhibitor (SGLT2i) use in the real world of China. We conducted this two-center, retrospective study to assess the incidence rate and risk factors of Dapagliflozin-associated DK/DKA among patients with type 2 diabetes mellitus (T2DM) in China. RESEARCH DESIGN AND METHODS Patients with T2DM treated with Dapagliflozin in Shanghai General Hospital were included in this retrospective analysis. Univariate and multivariate logistic regression was performed, and odds ratio (OR) and 95% confidence interval (CI) were calculated to identify the influencing factors associated with the occurrence of DK/DKA. RESULTS A total of 1985 T2DM patients received Dapagliflozin for the first time were included. The prevalence of DK and DKA was 2.47% and 0.35%, respectively. Multivariate logistic regression identified age <45 years [OR = 2.99, 95% CI (1.45-6.17)], concomitant use of Acarbose [OR = 2.18, 95% CI (1.06-3.38)], Metformin [OR = 1.84, 95% CI (1.01-3.38)], and Insulin [OR = 1.93, 95% CI (1.02-3.66)] as participating factors for DK/DKA. The 1:4 matched subset sensitivity analysis further confirmed the risk factors of Dapagliflozin-associated DK/DKA. CONCLUSIONS Age less than 45 years, concomitant use of Acarbose and insulin were risk factors for Dapagliflozin-associated DK/DKA. Clinicians should watch out for high-risk features among patients with SGLT2i prescription.
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Affiliation(s)
- Qingnan Zhao
- Department of Clinical Pharmacy, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Pancreatic Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yijiong Tan
- Department of Clinical Pharmacy, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qinqin Wu
- Department of Pharmacy, Community Health Service Center of Guangfulin Street, Shanghai, China
| | - Xiangqin Xiao
- Department of Clinical Pharmacy, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinyi Wei
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Mengqing Nian
- School of pharmacy, Nanjing Medical University, Nanjing, China
| | - Jie Yao
- School of pharmacy, Nanjing Medical University, Nanjing, China
| | - Nengguang Fan
- Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruiping Wang
- Clinical Research Center, Shanghai Skin Diseases Hospital, Tongji Medical University, Shanghai, China
| | - Guorong Fan
- Department of Clinical Pharmacy, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Sehgal M, Batra M, Jha P, Sanchez O. Risk Factors and Laboratory Findings Associated With Diabetic Ketoacidosis in Hospitalized Pediatric Patients. Cureus 2022; 14:e25410. [PMID: 35769689 PMCID: PMC9233933 DOI: 10.7759/cureus.25410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Diabetic ketoacidosis (DKA), the most serious and acute complication of type 1 diabetes, has an incidence of 6%-8% among known pediatric type 1 diabetes patients, although risk factors associated with severe DKA in the pediatric population are poorly understood [1]. Method: A single-institution, retrospective chart analysis of pediatric DKA patients admitted to our pediatric intensive care unit (PICU) was conducted in South Alabama between October 2017 and April 2021. Laboratory findings were obtained from venous samples collected from the patients on admission. Results: Of 429 admissions, 256 unique patients were admitted with DKA to PICU during the 3.5-year period; 55.9% of them were males. The median (IQR) age of the patients was 12 (10-15) years, and their median HbA1c level was 11.02 (10%-12%), which was similar to Medicaid and private insurance statistics (11.1 [9.87-12.2] vs 11 [9.65-12], p = 0.4). Serum pH on presentation was 7.17 (7.08-7.25), and serum bicarbonate was 10 (7-14) mmol/L. White blood cell (WBC) count, platelet count, and mean platelet volume (MPV) had a negative correlation with serum pH (r = -0.52, p < 0.001, r = -0.25, p = 0.01 and r = -0.11, p = 0.03, respectively). The blood urea nitrogen (BUN):creatinine ratio had a positive correlation with serum pH (r = 0.16, p < 0.001). Twenty-nine admissions (6.8%) with a median age of 16 (13-17) years required imaging for altered mental status, and none of these patients were diagnosed with cerebral edema. Conclusion: DKA is associated with noncompliance among pediatric patients, irrespective of their type of insurance. Markers of oxidative stress (WBC, platelets, and MPV) were associated with increased severity of DKA. The BUN:creatinine ratio may not provide accurate hydration status among DKA patients. Clinicians need to have a lower threshold for head imaging among younger patients.
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Hou L, Li X, Liu L, Wei H, Xiong F, Du H, Yang Y, Zhang H, Zhang Q, Yao H, Fu J, Yan X, Cui L, Liu G, Li T, Chen S, Li P, Xin Y, Liang X, Yu B, Dong Z, Chen R, Ma H, Cheng X, Luo F, Gong C, Song W, Chen X, Zhang Z, Peng X, Li G, Liang L, Maimaiti M, Cheung PT, Luo X. A Multicenter Survey of Type I Diabetes Mellitus in Chinese Children. Front Endocrinol (Lausanne) 2021; 12:583114. [PMID: 34211433 PMCID: PMC8239384 DOI: 10.3389/fendo.2021.583114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 05/17/2021] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To investigate the features and treatment status of children with type 1 diabetes mellitus (T1DM) in China. METHODS We recruited patients <14 years of age with T1DM from 33 medical centers in 25 major cities of China between January 2012 and March 2015. All patients completed a questionnaire that was conducted by their pediatric endocrinologists at all centers. RESULTS A total of 1,603 children (755 males and 848 females) with T1DM participated in this survey. Of these, 834 (52.03%) of the patients exhibited diabetic ketoacidosis (DKA) at onset, while 769 patients (47.97%) did not exhibit DKA (non-DKA) at onset. There was a higher proportion of females (55.71%) in the cohort of patients exhibiting DKA at onset than in the non-DKA cohort (49.33%). The mean age of patients exhibiting DKA at presentation was 7.12 ± 0.14 years; this was significantly younger than that in non-DKA group (7.79 ± 0.15 years; P < 0.005). The frequency of DKA in 3 years old, 3-7 years old, and 7 years old or more was 77.21%, 26.17%, and 37.62%, respectively. Upon initial diagnosis, 29.4%, 15.2% and 11.8% of patients showed positivity for glutamic acid decarboxylase antibody (GADA), Insulin autoantibodies (IAA), or islet cell antibody (ICA), respectively. During six months follow-up, 244 patients (15.21%) reported receiving insulin pump therapy, and more than 60% of patients monitored their blood glucose levels less than 35 times per week. Although the majority of patients had no problems with obtaining insulin, 4.74% of the children surveyed were not able to receive insulin due to financial reasons, a shortage of insulin preparations, or the failure of the parents or guardians to acquire the appropriate medicine. CONCLUSION DKA is more common in very young children. Treatment and follow-up of T1DM in China still face very serious challenges.
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Affiliation(s)
- Ling Hou
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiuzhen Li
- Department of Genetics and Endocrinology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Li Liu
- Department of Genetics and Endocrinology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hanyang Wei
- Department of Endocrinology and Genetic, Henan Provincial Children’s Hospital, Zhengzhou, China
| | - Feng Xiong
- Department of Endocrine and Genetic Metabolism Disease, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Hongwei Du
- Department of Pediatrics, The First Affiliated Hospital, Jilin University, Changchun, China
| | - Yu Yang
- Department of Endocrinology, Metabolism, and Genetics, Children’s Hospital of Nanchang University & Jiangxi Provincial Children’s Hospital, Nanchang, China
| | - Huifeng Zhang
- Department of Pediatrics, The Second Affiliated Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qin Zhang
- Department of Endocrinology, Shenzhen Children’s Hospital, Shenzhen, China
| | - Hui Yao
- Department of Endocrinology, Wuhan Children’s Hospital, Wuhan, China
| | - Junfen Fu
- Department of Endocrinology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoli Yan
- Department of Pediatrics Endocrinology, Xi’an Children’s Hospital, Xi’an, China
| | - Lanwei Cui
- Department of Pediatrics, The First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Geli Liu
- Department of Pediatrics, General Hospital of Tianjin Medical University, Tianjin, China
| | - Tang Li
- Department of Pediatrics, Qingdao Women and Children’s Hospital, Qingdao University, Qingdao, China
| | - Shaoke Chen
- Department of Pediatrics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Pin Li
- Department of Endocrinology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Xin
- Department of Pediatrics Endocrinology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiangrong Liang
- Department of Endocrinology, Qilu Children’s Hospital, Shandong University, Jinan, China
| | - Baosheng Yu
- Department of Pediatrics, The Second Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Zhiya Dong
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ruimin Chen
- Department of Endocrinology, Fuzhou Children’s Hospital, Fuzhou, China
| | - Huamei Ma
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xinran Cheng
- Department of Endocrinology and Metabolism, Chengdu Women’s and Children’s Central Hospital, Chengdu, China
| | - Feihong Luo
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children’s Hospital of Fudan University, Shanghai, China
| | - Chunxiu Gong
- Endocrinology, Genetics, and Metabolism, Beijing Diabetes Center for Children and Adolescents, Medical Genetics Department, Beijing Children’s Hospital, Beijing, China
| | - Wenhui Song
- Department of Pediatric Endocrinology, Shanxi Provincial Children’s Hospital, Taiyuan, China
| | - Xiaobo Chen
- Department of Endocrinology, Children’s Hospital of Capital Institute of Pediatrics, Beijing, China
| | - Zhixin Zhang
- Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China
| | - Xiangyun Peng
- Department of Endocrinology, Hunan Provincial Children’s Hospital, Changsha, China
| | - Guimei Li
- Department of Pediatrics, Shandong Provincial Hospital, Jinan, China
| | - Liyang Liang
- Department of Pediatrics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Mireguli Maimaiti
- Department of Pediatrics, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, China
| | - Pik To Cheung
- Paediatric Endocrinology, Genetics, and Metabolism, Virtus Medical Group and The University of Hong Kong, Hong Kong SAR, China
| | - Xiaoping Luo
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Xiaoping Luo,
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