Patients with type 2 diabetes (T2D) on sodium–glucose cotransporter 2 inhibitors (SGLT2i) may be at increased risk of pericolonoscopy ketoacidosis, attributed to bowel preparation, fasting, and inappropriate SGLT2i management. We recently reviewed the SGLT2i-linked perioperative euglycemic diabetic ketoacidosis (EDKA) risk (1) and reported pericolonoscopy EDKA in this context (2). Subsequently, we educated our institution about the importance of ketone monitoring in mitigating this risk and implemented pre- and postprocedure capillary ketone assessment for T2D patients undergoing colonoscopy. Using retrospective analysis, we aimed to determine the incidence of pericolonoscopy hyperketonemia in patients with T2D prescribed SGLT2i therapy, comparing its magnitude with non-SGLT2i therapy. We reviewed electronic records of patients undergoing colonoscopy at The Queen Elizabeth Hospital between July 2019 and August 2020 (Central Adelaide Local Health Network Human Research Ethics Committee, no. 14166). The FreeStyle Optium Neo H point-of-care kit (Abbott Laboratories, Abbott Park, U.K.) capable of measuring capillary blood glucose and β-hydroxybutyrate (BHB) was used in the measurement. The highest BHB value either before or after colonoscopy was deemed the periprocedure estimate. Hyperketonemia was defined as BHB >1.0 mmol/L.
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