SGLT-2 inhibitors were not linked with elevated rates of ketoacidosis but were associated with lower mortality and fewer readmissions in patients with heart failure.

Sodium-glucose cotransporter-2 (SGLT-2) inhibitors have become important in managing patients with diabetes, kidney disease and heart failure, but little is known about their risks and benefits in hospitalised patients. A chief concern is ketoacidosis, which can develop after acute infection and reduced oral intake – both commonly seen in hospitalised patients. Furthermore, euglycaemic ketoacidosis is more likely to be missed than its hyperglycaemic counterpart.

Researchers performed a meta-analysis of 23 randomised, controlled trials that involved 20,000 hospitalised patients (30% with diabetes) to compare outcomes between those who received SGLT-2 inhibitors and those who did not. Ketoacidosis rates were slightly, but not significantly, higher in those who received SGLT-2 inhibitors (0.21 vs 0.14 per 100 person-years). SGLT-2 inhibitor use was associated with significantly fewer readmissions and lower mortality in heart failure trials and a lower incidence of acute kidney injury overall. Twenty observational studies were analysed also, and did not show higher risk for ketoacidosis with SGLT-2 inhibitors.

Comment: The authors appropriately suggest caution in interpreting the nonsignificant difference in ketoacidosis with SGLT-2 inhibitors, as the results might have been underpowered, and the risk for ketoacidosis might have been underestimated because some studies included the outpatient follow up period, when risk likely would be lower. Nevertheless, this meta-analysis supports current recommendations to continue or initiate SGLT-2 inhibitors in hospitalised patients with heart failure if no contraindication exists.

Aaron J. Calderon, MD, FACP, SFHM, Program Director, Internal Medicine Residency, Saint Joseph Hospital; Clinical Professor of Medicine, Division of General Internal Medicine, University of Colorado School of Medicine, Denver, USA.

Gao FM, et al. A systematic review and meta-analysis on the safety and efficacy of sodium-glucose cotransporter 2 inhibitor use in hospitalized patients. Diabetes Care 2024; 47: 2275-2290.

This summary is taken from the following Journal Watch titles: General Medicine, Hospital Medicine.