{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T08:31:10Z","timestamp":1777883470146,"version":"3.51.4"},"reference-count":44,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100020950","name":"National Science and Technology Council","doi-asserted-by":"publisher","award":["MOST-112-2314-B-A49-080"],"award-info":[{"award-number":["MOST-112-2314-B-A49-080"]}],"id":[{"id":"10.13039\/501100020950","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Sage Open Chronic Disease"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Sodium-glucose cotransporter-2 inhibitors (SGLT2is) have significantly improved glycemic control and reduced cardiovascular and renal risks in type 2 diabetes mellitus (T2DM). However, diabetic ketoacidosis (DKA), though rare, remains a serious safety concern. While previous studies have established an elevated DKA risk with SGLT2is, real-world evidence in Asian populations remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>This study evaluated the real-world risk of DKA associated with SGLT2i use compared to dipeptidyl peptidase-4 inhibitors (DPP4is) in patients with T2DM in Taiwan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>A nationwide population-based cohort study using Taiwan\u2019s National Health Insurance Research Database.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This study included over 700,000 patients with T2DM who initiated SGLT2is or DPP4is between 2016 and 2020. A prevalent new-user design was applied, and inverse probability treatment weighting was used to balance baseline characteristics. DKA cases were identified using validated diagnostic codes from hospital admissions and emergency visits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The incidence of DKA was higher in SGLT2i users (0.34\u2009per 1000\u2009person-years (PY)) than in DPP4i users (0.19\u2009per 1000 PY), with an adjusted hazard ratio of 2.04 (95% CI: 1.64\u20132.54). Subgroup analyses revealed a consistently elevated DKA risk, particularly among men, older adults, and patients with advanced diabetes complications. Sensitivity analyses, including an\n                      <jats:italic toggle=\"yes\">E<\/jats:italic>\n                      -value of 3.72, suggested minimal impact from unmeasured confounders.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>SGLT2i use was associated with a twofold increased DKA risk compared to DPP4is in this Asian cohort. Although the absolute incidence was low, targeted monitoring is warranted in high-risk populations. The lower DKA incidence observed in Taiwan compared to Western studies suggests potential regional influences, necessitating further investigation. These findings contribute to the understanding of SGLT2i safety in Asian populations and inform clinical risk management strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/27558428261421697","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T15:16:11Z","timestamp":1773933371000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk of diabetic ketoacidosis with sodium-glucose cotransporter-2 inhibitors compared with dipeptidyl peptidase-4 inhibitors in type 2 diabetes: A nationwide cohort study"],"prefix":"10.1177","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-6592-0097","authenticated-orcid":false,"given":"Hsiao-Yun","family":"Yeh","sequence":"first","affiliation":[{"name":"Department of Medical Education, Taipei Veterans General Hospital, Taiwan"},{"name":"Department of Family Medicine, Taipei Veterans General Hospital, Taiwan"},{"name":"School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hong-Fu","family":"Lu","sequence":"additional","affiliation":[{"name":"Institute of Health and Welfare Policy, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liang-Yu","family":"Lin","sequence":"additional","affiliation":[{"name":"School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"},{"name":"Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li-Nien","family":"Chien","sequence":"additional","affiliation":[{"name":"Institute of Health and Welfare Policy, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,3,19]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1504720"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1812389"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1811744"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)32590-X"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.121.023811"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-022768"},{"key":"e_1_3_3_8_2","unstructured":"FDA Drug Safety Communication: FDA warns that SGLT2 inhibitors for diabetes may result in a serious condition of too much acid in the blood https:\/\/wayback.archive-it.org\/7993\/20170112031553\/http:\/\/www.fda.gov\/Drugs\/DrugSafety\/ucm446845.htm (2015)."},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/jdi.12401"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc1701990"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2024816"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2017.04.004"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1002\/pds.4887"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.7326\/M20-0289"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc21-2177"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(19)31291-4"},{"key":"e_1_3_3_17_2","article-title":"Sodium glucose cotransporter 2 inhibitors and risk of serious adverse events: nationwide register based cohort study","volume":"363","author":"Ueda P","year":"2018","unstructured":"Ueda P, Svanstrom H, Melbye M, et al. 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