Karl Winckel is a senior hospital pharmacist working at the Princess Alexandra (PA) Hospital. He has an interest in a wide range of clinical areas including evidence based medicine, cardiology, diabetes, mental health and geriatrics, however his main interest is in education and training.
He has coordinated extended training for nurses, allied health care workers, and doctors. He has also been heavily involved in developing training programs for hospital pharmacists and intern pharmacists.
As a conjoint member of staff working at the University of Queensland, Karl is involved in teaching in a wide range of areas including cardiology, diabetes care of the elderly, mental health, dermatology and neurology.
Ketoacidosis is a serious complication of diabetes, and is commonly caused by hyperglycaemia secondary to missed or inadequate insulin doses. In February this year the European Medicines Regulatory Agency (EMA) published information on ketoacidosis associated with sodium/glucose cotransporter 2 (SGLT2) inhibitors. This information listed ketoacidosis as a potential risk in patients taking SGLT2 inhibitors (a class of type 2 diabetes medicines). Rare cases of ketoacidosis, including life-threatening ones, have occurred in patients taking SGLT2 inhibitors for type 2 diabetes. Many of these cases have been atypical, with patients being euglycaemic instead of hyperglycaemic. This is problematic as many healthcare professionals may not be aware of the possibility of ketoacidosis in a patient with normal or mildly elevated blood glucose levels. This presentation aims to discuss the proposed mechanism, frequency, and prevention of ketoacidosis in patients taking SGLT2 inhibitors. It also aims to discuss whether causation exists between SGLT2 inhibitors and ketoacidosis or if these case reports are a result of confounding. The case of ketoacidosis with SGLT2 inhibitors will also be used as an example to discuss the problems of identification of rare adverse effects in clinical trials of new medicines which lack sufficient power to identify these adverse effects.