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Expanding Applications of Sodium-Glucose Cotransporter-2 Inhibitors (SGLT-2i) with Attention to Euglycemic Ketoacidosis (Eka) for No Diabetic History
Hiroshi Bando1,2iD*, Michael Wood1, Koji Ebe1,3
1Japan Low Carbohydrate Diet Promotion Association, Kyoto, Japan
2Medical Research/Tokushima University, Tokushima, Japan
3Takao Hospital, Kyoto, Japan
Corresponding Author: Hiroshi Bando ORCID iD
Address: Tokushima University /Medical Research, Nakashowa 1-61, Tokushima 770-0943, Japan.
Received date: 26 March 2025; Accepted date: 17 April 2025; Published date: 23 April 2025
Citation: Bando H, Wood M, Ebe K. Expanding Applications of Sodium-Glucose Cotransporter-2 Inhibitors (SGLT-2i) with Attention to Euglycemic Ketoacidosis (Eka) for No Diabetic History. Diab Res Open Access. 2025 Apr 23;6(1):06-10.
Copyright © 2025 Bando H, Wood M, Ebe K. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium provided the original work is properly cited.
Keywords: Sodium-Glucose Cotransporter-2 Inhibitors, Phlorizin, Ketone Bodies, Euglycemic Ketoacidosis, STICH Protocol, Euglycemic Diabetic Ketoacidosis
Abbreviations: SGLT-2i: Sodium-Glucose Cotransporter-2 Inhibitors; eKA: Euglycemic Ketoacidosis; eDKA: Euglycemic Diabetic Ketoacidosis
Abstract
Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) have their origins in phlorizin, which was discovered in apple bark in 1835. SGLT-2i has been effective in treating type 2 diabetes (T2D), chronic kidney disease (CKD), and cardiovascular disease (CVD). In heart failure, cardiac tissue becomes less able to metabolize glucose and fatty acids, and begins to rely more on ketone bodies. Subjects with heart failure with reduced ejection fraction showed higher cardiac output at rest and lower filling pressures, cardiac volumes, and NT-proBNP levels when treated with ketone esters. As an adverse effect of SGLT-2i, euglycemic ketoacidosis (eKA) has been reported and requires careful attention.