Clinical features and outcomes of diabetic ketoacidosis in patients using SGLT2 inhibitors: A systematic review and meta-analysis
Abstract
Aims: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are effective antihyperglycaemic agents; however, they also increase the risk of diabetic ketoacidosis (DKA). As the clinical evidence comparing DKA features between SGLT2i users and non-users remains limited due to the low incidence of DKA, this study aimed to compare the clinical features and outcomes of DKA in SGLT2i users and non-users by conducting a systematic review and meta-analysis.
Materials and methods: Relevant studies were searched in PubMed, Scopus, and Web of Science in February 2025. Studies that compared the clinical features or outcomes of DKA between SGLT2i users and non-users were included. Pooled estimates were derived using odds ratios for binary variables and mean differences for continuous variables.
Results: A total of 9 studies were analysed. DKA cases in SGLT2i users had lower odds of prior DKA and insulin use. Compared with DKA cases in non-users, SGLT2i users had lower glucose, HbA1c, creatinine, and lactate levels. No significant differences were found in the length of hospitalisation, intensive care unit admission, or in-hospital mortality.
Conclusions: These findings provide quantitative evidence of the distinct clinical features of SGLT2i-associated DKA, which may aid in early detection, management, and prevention in clinical practice.
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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