Periprocedural Euglycemic Diabetic Ketoacidosis Associated With Sodium–Glucose Cotransporter 2 Inhibitor Therapy During Colonoscopy

This case series describes the occurrence of euglycemic diabetic ketoacidosis (EDKA; varying severity) in 8 patients undergoing bowel preparation, who stopped their SGLT2 inhibitor on the day of colonoscopy

SPS commentary:

The authors say the risk of EDKA may be related to fluid and electrolyte shifts associated with bowel cleansing with an osmotic laxative, the effect of which may be potentiated by an SGLT2 inhibitor. Furthermore, a period of “low-residue diet" preceding bowel preparation may lead to a longer relative fasting period. They suggest that at a minimum, SGLT2 inhibitors should be stopped 2 days prior to colonoscopy to allow washout of the SGLT2i to start before bowel preparation. They call for further research to determine the incidence, define those at risk, identify the optimal time to stop SGLT2i, and determine the safety of proceeding with colonoscopy in patients with mild-to-moderate EDKA.


Diabetes Care