Sodium-glucose cotransporter-2-induced euglycemic diabetic ketoacidosis unmasks latent autoimmune diabetes in a patient misdiagnosed with type 2 diabetes mellitus: a case report

Various classification methods for diabetes mellitus in the management of blood glucose control

In the era of precision medicine, the classification of diabetes mellitus has evolved beyond the traditional categories. Various classification methods now account for a multitude of factors, including variations in specific genes, type of β-cell impairment, degree of insulin resistance, and clinical characteristics of metabolic profiles. Improved classification methods enable healthcare providers to formulate blood glucose management strategies more precisely. Applying these updated classification systems, will assist clinicians in further optimising treatment plans, including targeted drug therapies, personalized dietary advice, and specific exercise plans. Ultimately, this will facilitate stricter blood glucose control, minimize the risks of hypoglycaemia and hyperglycaemia, and reduce long-term complications associated with diabetes.

Evolving Clinical Features of Diabetic Ketoacidosis: The Impact of SGLT2 Inhibitors

Background/Objectives: The antidiabetic effect of SGLT2 inhibitors (SGLT2-is) is based on their ability to increase glucose excretion through urine by inhibiting the kidney-resident SGLT2 protein. Euglycemic diabetic ketoacidosis (EuDKA) is an uncommon but potentially life-threatening adverse effect of these medications, which are notable for their antidiabetic, cardiovascular, and renal protective properties. This study aimed to clarify the impact of SGLT2-is on demographic, clinical, and biochemical characteristics in patients with DKA. Methods: A total of 51 individuals with a diagnosis of DKA were included in the trial; 19 of these patients were treated with SGLT2-is, while 32 were not. Patients diagnosed with DKA and treated with SGLT2-is were compared to those not treated with the medication in terms of clinical, biochemical, and laboratory characteristics. Results: The age of patients utilizing SGLT2-is was statistically considerably greater than that of non-users (p < 0.001). EuDKA was exclusively noted in the SGLT2-is cohort (p = 0.005). Urinary tract infections, vulvovaginitis, and genitourinary infections were substantially more prevalent among SGLT2-i users compared with non-users among both women and the overall patient group (p = 0.036, p = 0.001, p = 0.005, p = 0.003, respectively). Plasma glucose concentrations were significantly higher in SGLT2-i non-users (p = 0.006). Chloride (Cl-) concentrations were elevated among SGLT2-i users (p = 0.036). Conclusions: The study findings indicate that SGLT2 inhibitors may substantially influence age, serum chloride, EuDKA, and the occurrence of genitourinary infections in individuals with DKA.