A case series of diabetic ketoacidosis associated with SGLT2 inhibitors

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are increasingly initiated as treatment for type 2 diabetes due to favourable cardiorenal characteristics. However, studies have identified an increased risk of diabetic ketoacidosis (DKA). We carried out a retrospective, case-based study at East and North Herts NHS Trust between February 2018 and December 2020. Fifteen cases of SGLT2i associated DKA were identified in people with presumed type 2 diabetes;33.3% were classed as euglycaemic DKA with a blood glucose of <11mmol/L. All cases were associated with a significant precipitating factor including diarrhoea, vomiting, reduced oral intake and sepsis. One case was related to COVID-19. Two people were subsequently found to have raised islet autoantibodies suggesting type 1 diabetes or latent autoimmune diabetes in adults. It is important that awareness of SGLT2i associated DKA is raised among users and health care practitioners, including the recognition of euglycaemic DKA. Sick day rules should be emphasised and reiterated at clinical encounters. Non-specialists in primary care, oncology and in perioperative settings should be empowered to advocate for temporary withdrawal and there should be readier access to blood ketone monitoring when required. When SGLT2i associated DKA occurs, due consideration should be given to evaluate the diabetes classification and investigate the circumstances of the event. Copyright © 2023 John Wiley & Sons.Copyright © 2023 John Wiley & Sons, Ltd.

Utilizing social media technology during the COVID-19 pandemic to assist highly vulnerable populations in the Philippines

National lockdowns and social distancing measures enforced in response to COVID-19 have forced many non-governmental organizations (NGOs) serving in low- and middle-income countries to suspend their operations. While low-income families continue to suffer from hunger and poverty, community quarantine restrictions additionally isolated them from town centers where healthcare, education, food, supplies, and livelihood opportunities are usually accessed. International Care Ministries (ICM) is a Philippine-based NGO that runs a poverty-alleviation program targeted towards extreme low-income households. As we re-evaluated how we may continue to effectively minister and serve our communities despite lockdown measures, we identified two priorities: (1) to serve people's physical needs by providing food and access to healthcare and (2) to serve people's spiritual needs through spiritual nourishment and community. In this field report, we describe how ICM was able to identify and use social network platforms as an alternative to continue both service delivery and spiritual feeding remotely. We hope this example may encourage other development NGOs to persevere as we all continue to seek ways to adapt to these extraordinary and seemingly ever-changing circumstances. © 2020 Center for Health in Mission. All rights reserved.