SGLT2 inhibitor in a Type 2 diabetes mellitus patient coexisted with central diabetes insipidus following hyperosmolar hyperglycemic state

Abstract Central diabetes insipidus (CDI) rarely develops following hyperglycemic hyperosmolar state (HHS) in type 2 diabetes mellitus (T2DM) patients. When a type 2 diabetes mellitus patient coexisted with central diabetes insipidus, it might be easily misdiagnosed when presenting only persisted hypernatremia with no sense of thirst. Herein we described a young woman with T2DM and HHS, who developed persistent hypernatremia without a sense of thirst, The diagnosis of CDI was delayed until she appeared polydipsia up to 10L/day after dapagliflozin was administered for glucose control. The absence of the low specific gravity urine was observed with a dapagliflozin treatment. With the cessation of dapagliflozin for 48 hours, the diagnosis of CDI manifesting polyuria with low specific gravity and osmolality was established by a water deprivation test and well-treated with oral desmopressin. It was indicated that an SGLT2 inhibitor may accelerate polyuria and affect urine osmolality by inhibiting glucose and sodium reabsorption in the proximal tubular. We suggest that it is necessary to stop SGLT2 inhibitors when a CDI is either suspected or established.