TABLE 3.
Consideration for Management of SGLT2 Inhibitor Use
| STICH (20) | International Consensus (18) | STOP DKA (19) | Anne L. Peters’ Protocol (14) | EMA Guidance (11,12) | NICE Guidance (21–23) | |
|---|---|---|---|---|---|---|
| Blood vs. urine ketone monitoring | Both are acceptable, although blood monitoring is more accurate | • Blood monitoring preferred | Only blood monitoring | Either blood or urine monitoring | Either blood or urine monitoring | NA |
| • Urine monitoring is acceptable if blood monitor not accessible/affordable | ||||||
| Frequency of routine ketone checks | Routine | • As a matter of routine, but individualized to the patient | NA | Every morning initially and then as needed based on symptoms or changes in habits and every 1–2 hours to track resolution of ketones if elevated | Individualized | NA |
| • Random or periodic measurements recommended | ||||||
| When to hold SGLT2i | 24 hours in advance of occurrences that cause decreased insulin dose (e.g., surgery, fasting, reduced carbohydrate intake, or prolonged physical activity) | • For increased physical activity | At least 3 days before major surgery | Hold SGLT2i for anything out of the ordinary (e.g., marked increase in physical activity, physical illness, any procedures, fasting, going on a diet, feeling sick, or travel) | NA | NA |
| • In situations where the person may become dehydrated, alter dietary intake, or consume more alcohol than usual |
SGLT2i, SGLT2 inhibitor.