SUN-590 SGLT2 Inhibitors Being Held In An Inpatient Setting Leading To Higher Rates Of DKA

Abstract Disclosure: A. McCaskey: None. SGLT2 inhibitors are becoming more widely prescribed both for their use in diabetes as well as heart failure1. SGLT2 inhibitors have known side effects including higher rates of UTI and euglycemic diabetic ketoacidosis. It is unclear whether SGLT2 inhibitors should be held upon admission to the hospital, especially in setting of acute infection or patients about to undergo surgery. This study was created to evaluate the incidence of patients developing euglycemic DKA while continued on their home SGLT2 inhibitors. 61,547 patients were analyzed in a meta-analysis excluding patients who presented with DKA or active heart failure exacerbation from January 2020 to March 2025. No statistical increase in euglycemic DKA was noted in patients with acute infection: UTI (p=0.205), pneumonia (p=0.313), sepsis (p=0.197), severe sepsis (p=0.197); between those who continued SGLT2 inhibitors while hospitalized versus those in which it was held during hospitalization. In these same groups, there was noted statistical significance in patients more likely to develop euglycemic DKA if their SGLT2 inhibitor were held with a p-value ≤ 0.0001 in all infection groups: UTI, pneumonia, sepsis, and severe sepsis. On the contrary, patients continuing SGLT2 inhibitors while undergoing surgery were more likely to develop euglycemic DKA while hospitalized (p≤0.05). It is more recommended to hold SGLT2 inhibitors in patients undergoing surgery. The specific surgeries studied were CABG, PCI, and hip replacement. It was also shown that patients continuing SGLT2 inhibitors while hospitalized had higher average length of stay of 6.40 days compared to 5.97 days in the withheld group even though the withheld group had less chance of developing DKA. However, patients that had their SGLT2 inhibitor continued had less length of stay in ICU level of care of 3.96 days compared to 4.49 days in the withheld group. Patients where SGLT2 inhibitor was continued also had significantly lower mortality of 104 compared to 1701 in the withheld group. Overall, patients had overall less risk of euglycemic diabetic ketoacidosis, ICU length of stay, and mortality if SGLT2 inhibitor was continued during hospitalization unless they were to undergo surgery while hospitalized. References: 1. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Paul A. Heidenreich, MD, MS, FACC, FAHA, FHFSA, et. al Presentation: Sunday, July 13, 2025