Clinical characteristics and outcomes of diabetes-related ketoacidosis (DKA) in sodium-glucose co-transporter-2 inhibitor (SGLT2i) users with type 2 diabetes
Abstract
Aim: Sodium-glucose co-transporter-2 inhibitors (SGLT2i) offer significant cardiorenal benefits for people with type 2 diabetes (PwT2D). However, concerns remain regarding their association with diabetes-related ketoacidosis (DKA). (1) To compare demographics, precipitating factors, biochemical features, management, and outcomes of acute DKA admissions between SGLT2i users (n = 267) and non-users (n = 793) with T2D. (2) To conduct a systematic review and meta-summary of published studies describing SGLT2i-associated DKA in T2D.
Methods: A retrospective cohort study analysed data from 18 UK hospitals (April 2018-March 2024), using standardised DKA protocols. Propensity score matching compared DKA episodes between SGLT2i users and non-users. In addition, a systematic review and meta-summary was performed including studies from PubMed, EMBASE, MEDLINE, Scopus, and Web of Science focusing on DKA in PwT2D treated with SGLT2i.
Results: Within the DEKODE cohort, 534 matched individuals were analysed. SGLT2i users had lower glucose, pH, and bicarbonate levels than non-users. SGLT2i was identified as the sole precipitant in 30.3% of cases. Despite lower admission glucose and more profound acidosis, both SGLT2i users and non-users had similar clinical outcomes including duration of DKA and length of hospital stay. In the meta-summary of 1024 cases of SGLT2 inhibitor-associated DKA from 247 studies, the median age was 54.6 years, with 49.7% male and a median diabetes duration of 10…
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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. Reported size: 793 participants or records.
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