The alarming side effect ketoacidosis associated with a class of type 2 diabetes drugs known as SGLT2 inhibitors may be triggered by low-carbohydrate diets, according to a small, randomized trial published in the journal Diabetes, Obesity, and Metabolism.
Head researcher Daisuke Yabe, MD, PhD, at Kyoto University Graduate School of Medicine in Japan, told Medscape Medical News that “We’re facing several concerns on adverse events of this drug class in clinical settings.” The study could help identify what causes these effects.
SGLT2 inhibitors are a newer yet popular class of drugs that include Invokana and Invokamet. Both drugs are approved by the Food and Drug Administration (FDA) to treat type 2 diabetes. They are not intended for patients with type 1 diabetes, though some doctors have prescribed it to type 1 diabetics, and some studies have tested the safety and efficacy of the drug in these patients.
In May 2015, the FDA warned that a number of both type 1 and type 2 diabetics treated with SGLT2 inhibitors had been diagnosed with ketoacidosis, or diabetic ketoacidosis (DKA). The condition occurs when too much acid builds up in the blood. If left untreated, ketoacidosis can lead to diabetic coma and death.
Some of the case reports of ketoacidosis had been in patients who were either fasting or following strict low-carb diets, but Yabe’s study was the first to formally demonstrate that SGLT2 inhibitors can enhance the production of ketone when fewer carbohydrates are consumed.
“Since carbohydrate restriction has been widely used to reduce body weight, doctors should question whether patients are on carbohydrate restriction or not, and if so they need to consult dietitians….Doctors should also mention a possible association of strict carbohydrate restriction with SGLT2-inhibitor–related euglycemic DKA to patients who initiate and continue SGLT2-inhibitor treatment,” Yabe advised.