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Objective: Sodium–glucose cotransporter 2 inhibitors (SGLT2i) have been associated with diabetic ketoacidosis at the time of colonoscopy. This study aimed to identify factors associated with ketone concentrations in SGLT2i‐treated type 2 diabetes compared with non‐SGLT2i‐treated diabetes, and those with impaired fasting glycaemia (IFG) and normoglycaemia. Design: Cross‐sectional, multicentre, observational study June–December 2020 in four Australian tertiary hospitals. Participants: Capillary glucose and ketones were measured in people undergoing colonoscopy: 37 SGLT2i‐treated and 105 non‐SGLT2i‐treated type 2 diabetes, 65 IFG and 151 normoglycaemia. Measurements: Body mass index (BMI), age, glucose, fasting duration and where relevant, HbA1c and time since last SGLT2i dose. Results: In SGLT2i‐treated diabetes, BMI (ρ = −0.43 [95% confidence interval: −0.67, −0.11]) and duration since last SGLT2i dose (ρ = −0.33 [−0.60, 0.00]) correlated negatively with increasing ketones, but there was no correlation with fasting duration. In non‐SGLT2i‐treated diabetes, BMI correlated negatively (ρ = −0.24 [−0.42, −0.05]) and fasting duration positively (ρ = 0.26 [0.07, 0.43]) with ketones. In IFG participants, only fasting duration correlated with ketones (ρ = 0.28 [0.03, 0.49]). In normoglycaemic participants, there were negative correlations with BMI (ρ = −0.20 [−0.35, −0.04]) and fasting glucose (ρ = −0.31 [−0.45, −0.15]) and positive correlations with fasting duration (ρ = 0.20 [0.04, 0.35]) and age (ρ = 0.19 [0.03, 0.34]). Multiple regression analysis of the entire cohort showed BMI, age and fasting glucose remained independently associated with ketones, but in SGLT2i‐treated participants only BMI remained independently associated. Conclusions: In SGLT2i‐treated diabetes, lower BMI was a novel risk factor for higher ketones precolonoscopy. Pending larger confirmatory studies, extra vigilance for ketoacidosis is warranted in these people. [ABSTRACT FROM AUTHOR]

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The article discusses the capillary ketone concentrations at the time of colonoscopy: a cross-sectional study with implications for SGLT2 inhibitor–treated type 2 diabetes. Topics include procedure centers where there is no access to on-site blood gas analyzers or expertise for dextrose-insulin infusions; and risk of diabetic ketoacidosis (DKA) in SGLT2i-treated people undergoing colonoscopy must be balanced by potential delays in detecting and treating colorectal cancer.