{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T04:17:18Z","timestamp":1788841038652,"version":"build-2803163510"},"reference-count":35,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T00:00:00Z","timestamp":1757289600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T00:00:00Z","timestamp":1757289600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["dom-pubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Obesity Metabolism"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>\n                      Sodium\u2010glucose co\u2010transporter\u20102 inhibitors (SGLT2i) offer significant cardiorenal benefits for people with type 2 diabetes (PwT2D). However, concerns remain regarding their association with diabetes\u2010related ketoacidosis (DKA). (1) To compare demographics, precipitating factors, biochemical features, management, and outcomes of acute DKA admissions between SGLT2i users (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009267) and non\u2010users (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009793) with T2D. (2) To conduct a systematic review and meta\u2010summary of published studies describing SGLT2i\u2010associated DKA in T2D.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort study analysed data from 18 UK hospitals (April 2018\u2013March 2024), using standardised DKA protocols. Propensity score matching compared DKA episodes between SGLT2i users and non\u2010users. In addition, a systematic review and meta\u2010summary was performed including studies from PubMed, EMBASE, MEDLINE, Scopus, and Web of Science focusing on DKA in PwT2D treated with SGLT2i.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Within the DEKODE cohort, 534 matched individuals were analysed. SGLT2i users had lower glucose, pH, and bicarbonate levels than non\u2010users. 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\u2010users had similar clinical outcomes including duration of DKA and length of hospital stay. In the meta\u2010summary of 1024 cases of SGLT2 inhibitor\u2010associated DKA from 247 studies, the median age was 54.6\u2009years, with 49.7% male and a median diabetes duration of 10\u2009years. Biochemical features included acidosis (median pH\u20097.1), elevated ketones (5.7\u2009mmol\/L), and modest hyperglycaemia (10.6\u2009mmol\/L). DKA typically developed after 2\u2009months of SGLT2i use, with 21.1% requiring intensive care admission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Despite lower admission glucose, more pronounced acidosis, and a higher incidence of hypokalaemia episodes, clinical outcomes were similar between the matched population of SGLT2i users and non\u2010users. This may be attributed to earlier identification of euglycaemic DKA, timely intervention, as well as the distinct pathophysiological profile of SGLT2i\u2010associated DKA. Improved education on risk factors and preventive strategies is warranted with SGLT2i therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.70098","type":"journal-article","created":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T11:01:41Z","timestamp":1757329301000},"page":"6999-7009","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Clinical characteristics and outcomes of diabetes\u2010related ketoacidosis (\n                    <scp>DKA<\/scp>\n                    ) in sodium\u2010glucose co\u2010transporter\u20102 inhibitor (\n                    <scp>SGLT2i<\/scp>\n                    ) users with type 2 diabetes"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8180-6388","authenticated-orcid":false,"given":"Angelica","family":"Sharma","sequence":"first","affiliation":[{"name":"Department of Endocrinology Norfolk and Norwich University Hospitals NHS Foundation Trust  Norwich UK"},{"name":"Department of Applied Health Sciences University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shams","family":"Ali Baig","sequence":"additional","affiliation":[{"name":"Birmingham Medical School University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rasiah","family":"Thayakaran","sequence":"additional","affiliation":[{"name":"Department of Applied Health Sciences University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lakshmi","family":"Rengarajan","sequence":"additional","affiliation":[{"name":"Department of Applied Health Sciences University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nevil C.","family":"Philip","sequence":"additional","affiliation":[{"name":"Department of Applied Health Sciences University of Birmingham  Birmingham 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Immunotherapy University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ketan","family":"Dhatariya","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Norfolk and Norwich University Hospitals NHS Foundation Trust  Norwich UK"},{"name":"Norwich Medical School University of East Anglia  Norwich UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3252-5026","authenticated-orcid":false,"given":"Guillermo E.","family":"Umpierrez","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Punith","family":"Kempegowda","sequence":"additional","affiliation":[{"name":"Department of Applied Health Sciences University of Birmingham  Birmingham UK"},{"name":"Queen Elizabeth Hospital University Hospitals Birmingham NHS Foundation 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FDA warns that SGLT2 inhibitors for diabetes may result in a serious condition of too much acid in the 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