LAUSR

Background: Some evidence suggests an association of SGLT2 inhibitors (SGLT2i) with an increased risk of euglycemic DKA (euDKA). The incidence and possible procedure-related triggers of metabolic abnormalities in patients taking SGLT2i after coronary angiography has not been well established. Methods: All patients with diabetes mellitus on a SGLT2i undergoing coronary angiography at a single center from November 2017 to November 2018 were reviewed for periprocedural characteristics and post-procedural metabolic abnormalities. Metabolic abnormalities were defined as: euDKA, DKA with hyperglycemia, or elevated urine ketones without confirmed acidosis. Results: A total of 44 patients with diabetes mellitus on a SGLT2i undergoing coronary angiogram were identified. There was one case of euDKA after angiography and one of hyperglycemic DKA. There was an additional two cases of patients with elevated urine ketones for whom DKA labs were not available. Baseline characteristics including age (p=0.71), type of SGLT2i (p=.20) and hemoglobin A1c (p=.49) were similar between the cases with metabolic abnormalities and those without. Similarly, procedural variables including indication for angiography (p=0.26), amount of contrast used (p=0.47), angiography outcome (p=0.87) and complications (p=0.40) were not statistically different between the groups. Conclusions: With a rare incidence and subtle clinical presentation, cases of euDKA may be missed after angiography, especially if acidosis is attributed to the preceding procedure without further workup. Continued case identification may help determine if specific procedural variables contribute to the development of euDKA. As the fasting state and stress of angiography can be triggers for ketosis, protocols should be developed for post-procedural screening and management in this population. Disclosure M. Shahid: None. S. Pickett: None. X. Jia: None. M. Alam: None. Y. Birnbaum: Other Relationship; Self; AstraZeneca. Other Relationship; Spouse/Partner; AstraZeneca, Boehringer Ingelheim International GmbH.