Predictors of diabetic ketoacidosis in patients with insulin‐deficient diabetes phenotype initiating SGLT2 inhibitors
Authors' conclusion
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/m2. Clinicians should exercise caution in these patients, carefully assessing risks and implementing mitigation strategies to ensure safe use.
Study context
- Population
- Patients with diabetes aged 18–70 with an insulin-deficient phenotype, no prior history of diabetic ketoacidosis (DKA)matched
- Participants
- 6,572 vs 6,382
- Exposure
- SGLT2i users vs non-users
- SGLT2i usersn = 6,572
- Non-usersn = 6,382reference
- Outcome
- First DKA event in patients with no prior history of DKA
- Follow-up
- Median 4.4 years
Methodological detailsmatched
- Matched
Main finding
As reported in the abstract
First DKA event
SGLT2i users vs Non-usersEstimate (95% CI)P value
First DKA event
HR 1.39(1.07–1.79)
P = 0.014Adjusted model
aHR 1.50(1.15–1.95)
P = 0.003- Patients with DKA
- 239
Observational data: associations, not effects.
Further findings
Independent risk factors for DKA (Cox regression)
- Baseline HbA1c >9%: aHR 1.53 (95% CI 1.18-1.99); p = 0.0016
- Body mass index (BMI) ≤25 kg/m²: aHR 1.61 (95% CI 1.24-2.09); p = 0.0003
- Insulin use: aHR 2.35 (95% CI 1.71-3.23); p < 0.0001
Original publication
Predictors of diabetic ketoacidosis in patients with insulin‐deficient diabetes phenotype initiating SGLT2 inhibitors. Diabetes Obes Metab. Published 19 June 2025. doi:10.
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