Predictors of diabetic ketoacidosis in patients with insulin‐deficient diabetes phenotype initiating SGLT2 inhibitors
Year: 2025
Type: article
Study design: Observational Study
Abstract: Aims To identify predictors of diabetic ketoacidosis (DKA) in patients with an insulin‐deficient phenotype initiating sodium‐glucose cotransporter 2 inhibitor (SGLT2i) therapy. Materials and Methods This retrospective cohort study analysed data from 31 900 patients with diabetes aged 18–70 identified as having an insulin‐deficient phenotype. After applying inclusion and exclusion criteria, patients were matched and divided into SGLT2i users ( n = 6572) and non‐users ( n = 6382). The primary endpoint was the first DKA event in patients with no prior history of DKA. Independent risk factors for DKA were assessed using Cox regression. Results Over a median follow‐up of 4.4 years, 239 patients experienced DKA (143 [2.22%] SGLT2i users vs. 96 [1.54%] non‐users; HR [95% confidence interval, CI] 1.39 [1.07–1.79]; p = 0.014). The adjusted model confirmed an increased DKA risk with SGLT2i use (adjusted hazard ratio, aHR [95% CI] 1.50 [1.15–1.95]; p = 0.003). Baseline HbA1c >9% was associated with a 53% higher risk (aHR [95% CI] 1.53 [1.18–1.99]; p = 0.0016), while body mass index (BMI) ≤25 kg/m 2 was linked to a 61% increased risk (aHR [95% CI] 1.61 [1.24–2.09]; p = 0.0003). Insulin use further heightened risk (aHR [95% CI] 2.35 [1.71–3.23]; p < 0.0001). Conclusions SGLT2i use in patients with an insulin‐deficient phenotype is associated with increased DKA risk, particularly in those with HbA1c >9% and BMI ≤25 kg/m 2 . Clinicians should exercise caution in these patients, carefully assessing risks and implementing mitigation strategies to ensure safe use.
Source: Diabetes Obesity and Metabolism
DOI: 10.1111/dom.16545
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $5,380
OpenAlex ID: W4411450868