J Endocrinol Metab

Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access

Article copyright, the authors; Journal compilation copyright, J Endocrinol Metab and Elmer Press Inc

Journal website https://www.jofem.org

Letter to the Editor

Volume 13, Number 4, November 2023, pages 170-173

The Safety of Sodium Glucose Cotransporter 2 Inhibitors for the Elderly Diabetic Patients

Figure 1. The underlying mechanism for SGLT2i-induced euglycemic DKA and elevation in triglyceride. Insulin with downward arrows include relative insulin deficiency due to increased insulin demand. SGLT2i: Sodium glucose cotransporter 2 inhibitors; DKA: diabetic ketoacidosis; ACC: acetyl-CoA carboxylase; C: cholesterol; CM: chylomicron; CPT-1: carnitine palmitoyl-transferase I; FFA: free fatty acids; HSL: hormone sensitive lipase; LPL: lipoprotein lipase; TCA: tricarboxylic acid; TG: triglyceride; TRL: TG-rich lipoproteins; VLDL: very-low-density lipoprotein.

**Table 1.** Possible Inducing Factors for Euglycemic Diabetic Ketoacidosis
Decreased plasma glucose and resulting in reduced insulin secretion
Low carbohydrate and energy intake
Increased physical exertion
Alcohol abuse
Decreased serum insulin level
Type 1 diabetes
Latent autoimmune diabetes in adults
Type 2 diabetes with reduced intrinsic insulin secretion (low body mass index)
Pancreatic diseases
Cessation of insulin or reduction of insulin dose
Cessation of insulin secretagogues
Increased demand for insulin
Surgery
Acute illness (infection, cerebral infarction, thyrotoxicosis)

Table 1. Possible Inducing Factors for Euglycemic Diabetic Ketoacidosis

Decreased plasma glucose and resulting in reduced insulin secretion

Low carbohydrate and energy intake

Increased physical exertion

Alcohol abuse

Decreased serum insulin level

Type 1 diabetes

Latent autoimmune diabetes in adults

Type 2 diabetes with reduced intrinsic insulin secretion (low body mass index)

Pancreatic diseases

Cessation of insulin or reduction of insulin dose

Cessation of insulin secretagogues

Increased demand for insulin

Surgery

Acute illness (infection, cerebral infarction, thyrotoxicosis)

**Table 2.** Advantages and Disadvantages of Measurements of Fasting C-Peptide and Triglyceride for the Evaluation of Intrinsic Insulin Secretion
	Advantages	Disadvantages
Fating C-peptide	Accurate and direct assessment of intrinsic insulin secretary capacity	Relatively difficult to obtain data measured
		Influenced by insulin injection and insulin secretagogues
Triglyceride	Easy to obtain data measured	Easily influenced by diet and exercise
	High sensitivity to detect insulin deficiency

Table 2. Advantages and Disadvantages of Measurements of Fasting C-Peptide and Triglyceride for the Evaluation of Intrinsic Insulin Secretion

Advantages

Disadvantages

Fating C-peptide

Accurate and direct assessment of intrinsic insulin secretary capacity

Relatively difficult to obtain data measured

Influenced by insulin injection and insulin secretagogues

Triglyceride

Easy to obtain data measured

Easily influenced by diet and exercise

High sensitivity to detect insulin deficiency