From the Guidelines
Jardiance is contraindicated in patients with a history of diabetic ketoacidosis (DKA) due to the increased risk of recurrent DKA episodes. According to the 2020 expert consensus decision pathway on novel therapies for cardiovascular risk reduction in patients with type 2 diabetes, a history of diabetic ketoacidosis is a consideration that may prompt caution or avoidance of SGLT2 inhibitors, such as Jardiance 1. Patients who have previously experienced DKA should not be prescribed this medication due to the potential for increased ketone production and reduced insulin levels, which can trigger ketoacidosis.
Key considerations for patients with a history of DKA include:
- Increased risk of recurrent DKA episodes
- Potential for underlying insulin deficiency or metabolic vulnerabilities
- Need for careful medication selection based on individual risk factors and medical history
- Alternative diabetes medications such as metformin, GLP-1 receptor agonists, DPP-4 inhibitors, or insulin therapy may be more suitable for these patients.
Healthcare providers should exercise caution when prescribing medications to patients with a history of DKA, and consider the potential risks and benefits of each medication option, as recommended by the American College of Cardiology solution set oversight committee 1.
From the FDA Drug Label
JARDIANCE is not recommended for patients with type 1 diabetes or for the treatment of diabetic ketoacidosis. Reports of ketoacidosis, a serious life-threatening condition requiring urgent hospitalization have been identified in postmarketing surveillance in patients with type 1 and type 2 diabetes mellitus receiving sodium glucose co-transporter-2 (SGLT2) inhibitors, including JARDIANCE.
Jardiance is not contraindicated in a patient with a history of DKA, but it is not recommended for the treatment of diabetic ketoacidosis 2.
From the Research
Jardiance Contraindication in Patients with History of DKA
- Jardiance, also known as empagliflozin, is a sodium-glucose cotransporter 2 (SGLT2) inhibitor used to treat type 2 diabetes mellitus.
- The use of SGLT2 inhibitors, including empagliflozin, has been associated with an increased risk of diabetic ketoacidosis (DKA) and euglycemic DKA 3, 4, 5.
- DKA is a life-threatening complication of diabetes that can occur in patients of all ages, and its diagnosis is traditionally based on the triad of hyperglycemia, metabolic acidosis, and elevated serum or urine ketones 4.
- However, the increasing incidence of euglycemic DKA has led to a de-emphasis on hyperglycemia in recent guidelines, and the use of SGLT2 inhibitors has been identified as a risk factor for this condition 4, 6.
- A meta-analysis of randomized controlled trials found no significant increase in the risk of ketoacidosis associated with SGLT2 inhibitors as a class, but individual studies have reported cases of DKA and euglycemic DKA in patients treated with empagliflozin 7, 3, 5.
- The treatment of DKA involves fluid and electrolyte replacement, insulin, and close monitoring to adjust therapy and identify complications, and prevention strategies include identifying diabetes before DKA develops and educating patients to manage high-risk situations 4.
- In patients with a history of DKA, the use of SGLT2 inhibitors, including empagliflozin, should be approached with caution, and careful monitoring of serum glucose, ketones, and acid-base status is recommended to prevent and diagnose DKA and euglycemic DKA 3, 4, 6.