Body mass index is inversely associated with capillary ketones at the time of colonoscopy: Implications for SGLT2i use.
OBJECTIVE
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been associated with diabetic ketoacidosis at the time of colonoscopy. This study aimed to identify factors associated with ketone concentrations in SGLT2i-treated type 2 diabetes compared with non-SGLT2i-treated diabetes, and those with impaired fasting glycaemia (IFG) and normoglycaemia.


DESIGN
Cross-sectional, multicentre, observational study June-December 2020 in four Australian tertiary hospitals.


PARTICIPANTS
Capillary glucose and ketones were measured in people undergoing colonoscopy: 37 SGLT2i-treated and 105 non-SGLT2i-treated type 2 diabetes, 65 IFG and 151 normoglycaemia.


MEASUREMENTS
Body mass index (BMI), age, glucose, fasting duration and where relevant, HbA1c and time since last SGLT2i dose.


RESULTS
In SGLT2i-treated diabetes, BMI (ρ = -0.43 [95% confidence interval: -0.67, -0.11]) and duration since last SGLT2i dose (ρ = -0.33 [-0.60, 0.00]) correlated negatively with increasing ketones, but there was no correlation with fasting duration. In non-SGLT2i-treated diabetes, BMI correlated negatively (ρ = -0.24 [-0.42, -0.05]) and fasting duration positively (ρ = 0.26 [0.07, 0.43]) with ketones. In IFG participants, only fasting duration correlated with ketones (ρ = 0.28 [0.03, 0.49]). In normoglycaemic participants, there were negative correlations with BMI (ρ = -0.20 [-0.35, -0.04]) and fasting glucose (ρ = -0.31 [-0.45, -0.15]) and positive correlations with fasting duration (ρ = 0.20 [0.04, 0.35]) and age (ρ = 0.19 [0.03, 0.34]). Multiple regression analysis of the entire cohort showed BMI, age and fasting glucose remained independently associated with ketones, but in SGLT2i-treated participants only BMI remained independently associated.


CONCLUSIONS
In SGLT2i-treated diabetes, lower BMI was a novel risk factor for higher ketones precolonoscopy. Pending larger confirmatory studies, extra vigilance for ketoacidosis is warranted in these people.
['Hamblin|Peter S|PS|https://orcid.org/0000-0002-6280-865X', 'Wong|Rosemary|R|http://orcid.org/0000-0002-6381-2458', 'Ekinci|Elif I|EI|https://orcid.org/0000-0003-2372-395X', 'Sztal-Mazer|Shoshana|S|http://orcid.org/0000-0002-3837-0125', 'Balachandran|Shananthan|S|', 'Frydman|Aviva|A|', 'Hanrahan|Timothy P|TP|http://orcid.org/0000-0002-3682-7400', 'Hu|Raymond|R|http://orcid.org/0000-0002-0169-0600', 'Ket|Shara N|SN|', 'Moss|Alan|A|', 'Ng|Mark|M|', 'Ragunathan|Sashikala|S|', 'Bach|Leon A|LA|http://orcid.org/0000-0002-9062-1518']
ketones colonoscopy diabetic ketoacidosis impaired fasting glycaemia diabetes mellitus, type 2 ketosis sodium-glucose transporter 2 inhibitors