Covid-19 vaccination for diabetics requires scrutiny, warns of research

Diabetic patients taking hypoglycemic drugs are at risk of rare Covid-19 complications. In particular, patients are using a popular class of diabetes drugs called sodium-glucose cotransporter 2 inhibitors (SGLT2i) that function by releasing excess glucose in the urine.

In diabetic patients, rare but serious cases such as diabetic ketoacidosis (DKA), which can be fatal if the cells do not receive enough glucose to promote their function due to illness or certain conditions. Complications may occur.Researchers at Brigham and Women’s Hospital have observed an increase in a particular type of DKA called euDKA during a pandemic.

EuDKA is a subset of diabetic complications known as DKA, in which the body’s cells are unable to absorb enough glucose and instead metabolize and supplement fat, causing the accumulation of acids called ketones.

What is EuDKA?

EuDKA differs from DKA in that it has low blood sugar levels and is difficult to diagnose.

Underlying almost all euDKA cases is starvation, which can be caused by diseases that cause vomiting, diarrhea, and loss of appetite, which can be exacerbated by the diuretic effects of SGLT2i drugs, US clinical endocrinology. A study published to the Society of Scholars states. Case report.

“We have the background to recognize that SGLT2 inhibitors can cause DKA and euDKA,” said Naomi Fisher, the corresponding author of the Endocrine, Diabetes and Hypertension department. “Our report is that if patients are ill, have anorexia, or are fasting, they should suspend their medication and not resume until they are healthy and properly eaten. Is emphasized. “

Brigham researchers investigated five unusual euDKA cases that were brought to diabetes hospitalization services within two months during the peak of the pandemic in Boston in the spring of 2020. Three of them occurred in a week.

Author’s advice

The authors also believe that Covid-19 may exacerbate the risk of euDKA in particular. When the virus infects a patient, it can bind to insulin-producing pancreatic cells and have toxic effects on them.

Early SARS-CoV-1 virus studies found that many infected patients had elevated blood sugar levels. “It has been speculated through other models that the virus may preferentially destroy insulin-producing cells,” Fisher said.

The authors recommend that patients and doctors discontinue use of SGLT2i in the case of illness, which is the standard practice of metformin, the most common diabetes drug.

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