Mishra HK, Ying NM, Luis A, Wei H, Nguyen M, Nakhla T, et al
A meta-analysis of RCTs in adults with type 1 diabetes showed an increased probability of DKA with SGLT-2 inhibitor therapy compared with placebo (odds ratio 3.38).5 A 2016 review of the existing evidence by an expert panel in Canada found that in T2DM trials, the incidence of DKA was estimated to be 0.160.76 per 1000 patient-years and patients could present with normal blood glucose levels.7 A case series found that about 70% of patients presenting with DKA were euglycemic.7 Overall, data from trials showed that DKA asssociated with SGLT-2 inhibitors occurred more commonly in patients who were dependent on insulin.7 Adverse event databases have also shown that DKA is associated with use of SGLT-2 inhibitors, with over 200 DKA events in adults reported with canagliflozin in Canada11 and 8968 cases of DKA associated with canagliflozin, dapagliflozin or empagliflozin reported in the US,12 of which 15 involved patients under age 18, of whom 3 had T2DM.12 More cases of DKA associated with use of SGLT-2 inhibitors may have gone unreported, and further study in the pediatric population is needed
Folate is needed for development and growth of cells (including red blood cells) and synthesis of DNA (genetic material)
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