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Euglycemic diabetic ketoacidosis (DKA) is relatively uncommon, but its incidence seems to be increasing. Sodium–glucose cotransporter-2 (SGLT-2) inhibitors have known association with excess risk for DKA (NEJM JW Gen Med Sep 1 2020 and Ann Intern Med 2020; 173:417) and particularly with euglycemic DKA (Diabetes Care 2015; 38:1638). In a retrospective study, investigators identified 510 adults (all from a single U.S. healthcare institution) with DKA; in 11% of these cases, DKA was euglycemic. Notably, euglycemic DKA incidence increased over the course of the study — from 7% of patients with DKA in 2018 to 16% in 2023.
SGLT-2 inhibitor use prior to DKA admission was significantly more common in patients with euglycemic DKA than with traditiona…