Canagliflozin Causing DKA

Canagliflozin is a SGLT2-inhibitor approved only for use in T2DM.  However, it is prescribed off-label for T1DM and it may increase DKA risk in type 1 diabetics.
n = 351 T1DM patients (mean age, 42) randomized to receive 18 wks of canagliflozin or placebo + insulin.
Industry-supported trial.
DKA occurred in 12 of 234 recipients (5%) vs no placebo recipients.
Infection, insulin pump malfunction and suboptimal insulin adherence were precipitants.
5 of 12 had glucoses relatively low for DKA (<250).
Summary:  mechanism could be increased glycosuria blunting development of hyperglycemia in DKA, causing patients to underdose insulin and promote clinical progression to DKA.  The SGLT-2 inhibitors should not be prescribed to T1DM nor DKA-prone T2DM.
Diabetes Care 2016 Apr; 39:532

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