E-Poster Presentation ESA-SRB-ANZBMS 2021

The role of SGLT2 inhibitors in achieving glycaemic control in maturity-onset diabetes of the young type 3 (#389)

Arunan Sriravindrarajah 1 2 , Amelia Fernandes 1 3 , Ted Wu 1 2 , Samantha Hocking 1 2 4
  1. Royal Prince Alfred Hospital, Sydney, NSW, Australia
  2. Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
  3. Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
  4. Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia

Introduction: Maturity-onset diabetes of the young type 3 (MODY3) accounts for approximately 50% of cases of MODY. First-line treatment with sulfonylureas has been well established for individuals with MODY3. In contrast, the role of sodium-glucose co-transporter 2 (SGLT2) inhibitors in the treatment of individuals with MODY3 remains unclear.

Case Presentation: A 30-year old Caucasian female was admitted with osteomyelitis and septic arthritis of the right 1st metatarsal bone and metatarsophalangeal joint in the setting of a chronic diabetic foot ulcer present for 15 months. She had a background of MODY3 treated with supramaximal gliclazide MR 120mg BD and metformin XR 2g BD At the time of her admission, C-Reactive Protein (CRP) was 27.3mg/L and an x-ray showed erosion of the 1st metatarsal head and proximal phalanx consistent with osteomyelitis and likely septic arthritis. Her HbA1C was 8.3% and she had persistent hyperglycaemia with capillary blood glucose levels (BGL) ranging from 5.9 mmol/L to 18.0 mmol/L. Empagliflozin 10mg daily was commenced in addition to her regular gliclazide MR 120mg BD and metformin XR 2g BD. Her glycaemic control immediately improved with her BGL ranging from 4.2 mmol/L to 7.5 mmol/L (Figure 1). The weighted average BGL was reduced from 8.53 mmol/L to 5.65 mmol/L after the initiation of empagliflozin, and consequently her pre-existing oral hypoglycaemic medications were reduced to the maximum recommended daily doses. Her foot ulcer improved with a reduction in pain, erythema and slough. Her CRP declined to 1.1mg/L, and she was discharged on oral Flucloxacillin for a further four weeks. Her ulcer has continued to heal, the osteomyelitis has resolved and she has now commenced mobilising with an off-loading boot.

Conclusion: This case suggests SGLT2 inhibitors may be an effective and potent treatment option in addition to sulfonylureas for individuals with MODY3.

 

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