Sodyum glukoz ko-transporter 2 inhibitörleri ile diyabetik ketozis ve enfeksiyon arasındaki ilişki: Tek merkez deneyimi
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Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Kırıkkale Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş ve Amaç: Diyabet ülkemizde ve dünyada önemli bir toplumsal problemdir. Kan şekeri yüksekliğinin ötesinde tüm sistemlerde yaygın ve hayati olabilecek komplikasyonlara sebep olmaktadır. Bu sebeple diyabet yönetiminde kan şekeri düzenlemesinin ötesinde bütüncül yaklaşım ve komplikasyonlar ile mücadele önemli yer tutmaktadır. Sodyum glukoz ko-transporter-2 (SGLT-2) inhibitörleri pek çok antidiyabetik ilaç ailesinden biri olup, güçlü kan şekere regülasyonu ve bundan bağımsız olarak kardiyak ve renal koruyucu etkiler ile öne çıkmaktadır. Güçlü etkinliğine rağmen diyabetik ketozis ve enfeksiyon açısından riskli görülmektedir, bu durum kullanımlarını kısıtlamaktadır. Biz SGLT2-i ile diyabetik ketozis ve enfeksiyon arasındaki ilişkiyi inceleyerek endişelerin haklılığını araştırmayı hedefledik. Gereç ve Yöntem: Çalışmamız tek merkezli ve retrospektif tasarlanmıştır. Ocak 2020 ve haziran 2023 tarihlerinde diyabetik ketozis ile kliniğimizde yatarak tedavi edilmiş olan ve 18 yaşından büyük 152 hasta çalışmaya dahil edilmiştir. Bu hastalarda ketozis ve eğer var ise enfeksiyon kliniğinin şiddeti SGLT-2 inhibitörü kullanan tip 2 diyabet hastaları, SGLT-2 inhibitörü kullanmayan tip 2 diyabet hastaları ve tip 1 diyabet hastaları arasında çeşitli parametreler aracılığıyla incelenmiştir. Bu parametreler hastanın başvuru sırasındaki ve taburculuğundaki; kan ve idrar biyokimya tetkikleri, ketozis tedavi süresi, intravenöz antibiyotik kullanım süresi, hastanede yatış süresi olarak belirlenmiştir. Bulgular: Çalışma kapsamında SGLT-2 inhibitörü kullanan tip 2 diyabetik hastalar, kullanmayan tip 2 diyabetik hastalar ile tip 1 diyabetik hastalar karşılaştırıldı. SGLT-2 inhibitörü kullanan hastalarda idrar yolu enfeksiyonunun göstergesi olarak idrarda lökosit anlamlı olarak daha yüksek saptandı(p<0.002). Hastaların başvuru sırasındaki kan gazı ve biyokimya tetkikleri ketozis şiddeti açısından kıyaslandığında gruplar arasında anlamlı farklılık saptanmadı. Ketozis tedavi süresi, intravenöz antibiyotik kullanım süresi ve hastane yatış süresi açısından anlamlı fark saptanmadı. Sonuç: SGLT-2 inhibitörleri ile ilişkilendirilen ketoasidoz ve enfeksiyon komplikasyonlarının yönetilebilir ve kontrol edilebilir tablolar olduğuna dair verilere ulaştığımızı düşünüyoruz. Buna dayanarak ek sistemik faydalarını tekrar vurgulayarak, SGLT-2 inhibitörlerinin yan etkileri hakkında daha fazla ileri araştırma yapılması gerektiğini ve bu ajanların diyabetik tedavideki yerinin tartışılması gerektiğini öneriyoruz. Anahtar Kelimeler: diabetes Mellitus, diyabetik ketozis, diyabetik ketoasidoz, Sodyum glukoz ko-transporter 2 inhibitörleri, enfeksiyon, antibiyotik
Introduction and Objective: Diabetes is a serious social problem in our country and in the world. Beyond hyperglycemia, it causes common and potentially life- threatening complications in all systems. For this reason, beyond the regulation of blood glucose, a holistic approach and combating complications are important in diabetes management. Sodium glucose co-transporter 2 inhibitors (SGLT2-i) are one of many antidiabetic drug families and stand out with their strong blood sugar regulation and cardiac and renal protective effects independent of blood sugar decrease. Despite its strong effectiveness, it is seen as risky in terms of diabetic ketosis and infection, which limits its use. We aimed to investigate the legitimacy of concerns by examining the relationship between SGLT-2 inhibitors and diabetic ketosis/infection. Materials and Methods: Our study was designed single-center and retrospectively. 152 patients over the age of 18 who were treated as inpatients in our clinic with diabetic ketosis between January 2020 and June 2023 were included in the study. In these patients, ketosis and the severity of the infection clinic, if any, were examined through various parameters among Type 2 diabetic patients using SGLT-2 inhibitors, Type 2 diabetic patients not using SGLT-2 inhibitors, and Type 1 diabetes patients. These parameters were determined as the patient's blood and urine biochemistry tests at admission and discharge, duration of ketosis treatment, duration of intravenous antibiotic use, and duration of hospitalization. Results: Within the scope of the study, type 2 diabetic patients using SGLT-2 inhibitors were compared with type 2 diabetic patients not using SGLT-2 inhibitors and type 1 diabetic patients. In patients using SGLT-2 inhibitors, leukocyte count in urine, an indicator of urinary tract infection, was found to be significantly higher (p<0.002). When the blood biochemistry tests of the patients at the time of admission were compared in terms of ketosis severity, no significant difference was detected between the groups. No significant difference was detected in terms of ketosis treatment duration, intravenous antibiotic use duration and hospitalization duration. Conclusion: We believe that we have obtained data showing that ketoacidosis and infection complications associated with SGLT-2 inhibitors are manageable and controllable. Based on this, we recommend that further research should be conducted on the side effects of SGLT-2 inhibitors, reemphasizing their additional systemic benefits, and that the place of these agents in diabetic treatment should be discussed. Keywords: diabetes mellitus, diabetic ketosis, diabetic ketoacidosis, Sodium glucose co-transporter 2 inhibitors, infection, antibiotics
Introduction and Objective: Diabetes is a serious social problem in our country and in the world. Beyond hyperglycemia, it causes common and potentially life- threatening complications in all systems. For this reason, beyond the regulation of blood glucose, a holistic approach and combating complications are important in diabetes management. Sodium glucose co-transporter 2 inhibitors (SGLT2-i) are one of many antidiabetic drug families and stand out with their strong blood sugar regulation and cardiac and renal protective effects independent of blood sugar decrease. Despite its strong effectiveness, it is seen as risky in terms of diabetic ketosis and infection, which limits its use. We aimed to investigate the legitimacy of concerns by examining the relationship between SGLT-2 inhibitors and diabetic ketosis/infection. Materials and Methods: Our study was designed single-center and retrospectively. 152 patients over the age of 18 who were treated as inpatients in our clinic with diabetic ketosis between January 2020 and June 2023 were included in the study. In these patients, ketosis and the severity of the infection clinic, if any, were examined through various parameters among Type 2 diabetic patients using SGLT-2 inhibitors, Type 2 diabetic patients not using SGLT-2 inhibitors, and Type 1 diabetes patients. These parameters were determined as the patient's blood and urine biochemistry tests at admission and discharge, duration of ketosis treatment, duration of intravenous antibiotic use, and duration of hospitalization. Results: Within the scope of the study, type 2 diabetic patients using SGLT-2 inhibitors were compared with type 2 diabetic patients not using SGLT-2 inhibitors and type 1 diabetic patients. In patients using SGLT-2 inhibitors, leukocyte count in urine, an indicator of urinary tract infection, was found to be significantly higher (p<0.002). When the blood biochemistry tests of the patients at the time of admission were compared in terms of ketosis severity, no significant difference was detected between the groups. No significant difference was detected in terms of ketosis treatment duration, intravenous antibiotic use duration and hospitalization duration. Conclusion: We believe that we have obtained data showing that ketoacidosis and infection complications associated with SGLT-2 inhibitors are manageable and controllable. Based on this, we recommend that further research should be conducted on the side effects of SGLT-2 inhibitors, reemphasizing their additional systemic benefits, and that the place of these agents in diabetic treatment should be discussed. Keywords: diabetes mellitus, diabetic ketosis, diabetic ketoacidosis, Sodium glucose co-transporter 2 inhibitors, infection, antibiotics
Açıklama
Tıp Fakültesi, İç Hastalıkları Ana Bilim Dalı
Anahtar Kelimeler
İç Hastalıkları, Internal diseases
