Predictors of Ketoacidosis with SGLT-2 Inhibitors in Patients with Type 2 Diabetes

Ketoacidosis is an uncommon but feared adverse effect of sodium–glucose cotransporter-2 (SGLT-2) inhibitors in patients with type 2 diabetes mellitus (T2DM). Little is known about risk factors for ketoacidosis in routine use of these medications.

Using nationwide registry data from three Scandinavian countries, researchers studied ≈280,000 adults with T2DM (mean age 63; 36% women) who were prescribed an SGLT-2 inhibitor (most commonly dapagliflozin or empagliflozin). They compared patients with ketoacidosis to controls without ketoacidosis (matched by age and sex) to identify risk factors and precipitating events (Figure 1).