Dennis Perez Castillo

Evidence on sodium-glucose co-transporter-2 inhibitors (SGLT2i)-associated euglycaemic diabetic ketoacidosis (EuDKA) in the intensive care unit (ICU) and its comparison with type 1 diabetes mellitus (T1DM) diabetic ketoacidosis (DKA) is limited. This study aims to describe ICU characteristics, management and outcomes of SGLT2i-associated EuDKA, identify predictors of poorer outcomes and compare findings with T1DM-DKA. Single-centre retrospective cohort (2017–2023) of adults admitted to a Northern Queensland ICU. EuDKA was defined by plasma glucose <13.9 mmol/L plus ⩾1 of acidaemia, low bicarbonate, raised anion gap or ketonaemia, in patients with T2DM on SGLT2i. A comparator cohort comprised ICU admissions with T1DM-DKA. Demographics, precipitants, biochemistry, insulin therapy, and outcomes were extracted and analysed with non-parametric tests. Fourteen EuDKA and 31 T1DM-DKA admissions were included. EuDKA patients were older with more frequent comorbidities; First Nations Australians were over-represented. Presenting features were heterogeneous, with overlapping precipitants (commonly caloric restriction/fasting or intercurrent illness). Compared with T1DM-DKA, EuDKA had milder biochemical derangement and lower 24-h insulin dose but required longer insulin therapy and longer ICU length of stay; time to acidosis resolution was similar. In exploratory analyses, end-organ complications in type 2 diabetes were associated with longer ICU stay, while obesity and pre-admission insulin therapy were associated with prolonged acidosis duration. ICU-admitted SGLT2i-associated EuDKA differs clinically and in management from classical T1DM-DKA. Findings highlight diagnostic challenges, potential high-risk subgroups, and the need for prospective, multicentre studies to inform risk-based management in critical care.

The “Optimal care pathway for people with colorectal cancer” (CRC OCP) was published to provide Australian clinicians with a framework to deliver high‐quality, timely care to patients; however, it is unknown whether this has affected outcomes across Australia. This review aimed to identify and summarize the available literature on concordance with the CRC OCP. A literature search was conducted across six databases. Articles were included if they reported CRC OCP timelines to measure diagnosis and delivery of care, or reported barriers or facilitators to implementation of the CRC OCP for timely diagnosis and care in Australia. Of the 631 articles screened, 12 articles met the inclusion criteria. Aspects of the pathway assessed had variable concordance. The articles included qualitative and/or qualitative analyses of CRC OCP concordance, variously reporting the impact of direct‐access colonoscopy clinics, time intervals, rates of CRC OCP adherence, and the influence of patient and healthcare system factors. The limited number of articles in this review and variable results may suggest the CRC OCP is yet to be integrated nationally.

Perioperative euglycaemic diabetic ketoacidosis (EuDKA) is a rare but life-threatening complication associated with sodium-glucose co-transporter-2 inhibitors (SGLT2i). It is characterised by ketonaemia, acidosis, and normal serum glucose. Whilst guidelines advise withholding SGLT2i prior to elective surgery, limited guidance exists for emergency procedures. This systematic review aimed to describe EuDKA cases following emergency surgery, identify patient characteristics, and examine contributing risk factors. A search of electronic databases up to April 2024 identified 30 cases from 21 publications. In most cases, EuDKA onset occurred within three days postoperatively (range: intraoperative to 10 days). Reported risk factors included inadequate SGLT2i withholding time, poor glycaemic control, morbid obesity, major surgery, intercurrent illness, suboptimal intraoperative diabetes management, and delayed gastrointestinal absorption. Morbidity was significant: ten patients required intensive care, two required intubation and ventilation, two received dialysis, and one underwent exploratory laparotomy. No deaths were reported. Due to atypical biochemical findings and non-specific symptoms, EuDKA remains under-recognised. Clinicians are advised to maintain a high index of suspicion, ensure appropriate perioperative insulin management, conduct vigilant laboratory monitoring, and provide patient education to reduce the risk in emergency surgical settings.