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Diabetes with heart failure — GPhC CRA MCQ

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HardEndocrine TherapeuticsDiabetes with heart failureGPhC CRA

A patient taking empagliflozin for type 2 diabetes and heart failure has recovered from confirmed diabetic ketoacidosis precipitated by gastroenteritis. Ketones and pH are now normal, renal function has returned to baseline and the infection has resolved. The discharge team proposes automatic restart because capillary glucose is 8.2 mmol/L. What is the best advice?

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Correct answer: B — Reconsider only after confirming the precipitant was identified and resolved and reviewing benefit versus risk

MHRA advises that an SGLT2 inhibitor should not routinely be restarted after DKA occurring during treatment. Restart can be considered only when another cause for DKA was identified and resolved, with an individual benefit–risk review. Normal current glucose, ketones and renal function do not by themselves establish that restart is safe. Dose reduction or switching within the class does not remove the class risk, while a permanent absolute ban overstates the advice when a clear reversible precipitant has been established.

Reference: MHRA: SGLT2 inhibitors—updated advice on diabetic ketoacidosis. https://www.gov.uk/drug-safety-update/sglt2-inhibitors-updated-advice-on-the-risk-of-diabetic-ketoacidosis