Clinical Severity of Diabetic Ketoacidosis by SGLT2 Inhibitors Use: A Retrospective Observational Study

Sodium glucose cotransporter 2 inhibitors (SGLT2i) are commonly used glucose lowering agents with established cardiac and kidney benefits. Diabetic ketoacidosis (DKA) is a rare complication associated with their use, which entails significant morbidity and mortality.

This retrospective observational study included patients with diabetes (any) admitted with DKA to a large tertiary hospital. Demographic, clinical and laboratory data were extracted from electronic medical records. Outcomes included DKA severity as determined by nadir pH, duration of stay, need for intensive care (ICU) and inpatient mortality.

Baseline SGLT2i use was documented in 27/191 patients (14.1%). SGLT2i users had lower nadir pH (7.08 ± 0.15 vs. 7.15 ± 0.12, p = 0.006) and were more likely to have severe DKA (29.6% vs. 12.2%, p = 0.007). After adjusting for multiple covariates, SGLT2i use remained independently associated with DKA severity. ICU admission and hospitalisation duration did not differ between the groups. Inpatient mortality occurred in 3/27 users and 3/164 non-users, while the composite outcome of mortality and/or ICU admission was similar (74.1% vs. 72.0%, p = 0.819). Findings remained consistent after excluding patients with new-onset diabetes.

Among patients hospitalised with DKA in a large tertiary centre, SGLT2i use was associated with a more severe biochemical presentation, reflected by a lower nadir pH. The observed difference in inpatient mortality was based on few events and should be interpreted cautiously.