NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update

SGLT2 Inhibitors diabetic ketoacidosis risk

SGLT2 (sodium-glucose co-transporter 2) inhibitors are licensed for use in type 2 diabetes to improve diabetic control. We highlighted preliminary advice on the risks of diabetic ketoacidosis (DKA) in 2015. Further guidance has since been published in the MHRA Drug Safety Update.


Points to note from the new guidance are as follows:


  • DKA is a rare side effect of SGLT2 inhibitors
  • A substantial proportion of reports of DKA involved off-label use in patients with type 1 diabetes.  SGLT2 Inhibitors should NOT be used in type 1 diabetes.
  • The presentation of DKA in patients on SGLT2 inhibitors is atypical, with only mildly elevated blood glucose levels, so it is important for prescribers and patients to be alert to the symptoms of ketoacidosis (refer to MHRA Drug Safety Update for details) and take appropriate action.



Suggested actions to reduce the risk of patients on SGLT2 inhibitors developing DKA are:


  • Inform patients of the symptoms of DKA and action to be taken if they develop.  Also discuss the above risk factors with patients on SGLT2 inhibitors and use with caution in people who have them.
  • Discontinue the SGLT2 inhibitor immediately if DKA is suspected or diagnosed and do not re-start unless another cause for the DKA is identified and treated.
  • Interrupt treatment if a patient on an SGLT2 is admitted to hospital for major surgery or acute serious illness.  Only re-start when stable.
  • Report suspected side effects to SGLT2 inhibitors on a Yellow Card.


Published July 6th 2016