Evidence map›Paper›PMID 40919651›Full record

SynthesisDiabetes, obesity & metabolism2025

Clinical characteristics and outcomes of diabetes-related ketoacidosis (DKA) in sodium-glucose co-transporter-2 inhibitor (SGLT2i) users with type 2 diabetes.

Angelica Sharma, Shams Ali Baig, Rasiah Thayakaran, Lakshmi Rengarajan, Nevil C Philip, Anu Ann Abraham, Aspasia Manta, Parth Narendran, Ketan Dhatariya, Guillermo E Umpierrez and 2 more

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Diabetes, obesity & metabolism, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Observational
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Angelica SharmaDepartment of Endocrinology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.ORCID https://orcid.org/0000-0001-8180-6388
Shams Ali BaigBirmingham Medical School, University of Birmingham, Birmingham, UK.
Rasiah ThayakaranDepartment of Applied Health Sciences, University of Birmingham, Birmingham, UK.
Lakshmi RengarajanDepartment of Applied Health Sciences, University of Birmingham, Birmingham, UK.
Nevil C PhilipDepartment of Applied Health Sciences, University of Birmingham, Birmingham, UK.
Anu Ann AbrahamDepartment of Applied Health Sciences, University of Birmingham, Birmingham, UK.
Aspasia MantaDepartment of Applied Health Sciences, University of Birmingham, Birmingham, UK.ORCID https://orcid.org/0000-0002-3420-1420
Parth NarendranQueen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Ketan DhatariyaDepartment of Endocrinology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
Guillermo E UmpierrezDivision of Endocrinology and Metabolism, Emory University School of Medicine, Atlanta, Georgia, USA.ORCID https://orcid.org/0000-0002-3252-5026
Punith KempegowdaDepartment of Applied Health Sciences, University of Birmingham, Birmingham, UK.
DEVI collaborationDepartment of Applied Health Sciences, University of Birmingham, Birmingham, UK.

Funding

ABCD and Sanofi DKA Collaborative Working Project GrantAdvanced Clinician Scientist FellowshipNational Institute for Health and Care Research
6 · The paper itself

Abstract

aimSodium-glucose co-transporter-2 inhibitors (SGLT2i) offer significant cardiorenal benefits for people with type 2 diabetes (PwT2D). However, concerns remain regarding their association with diabetes-related ketoacidosis (DKA). (1) To compare demographics, precipitating factors, biochemical features, management, and outcomes of acute DKA admissions between SGLT2i users (n = 267) and non-users (n = 793) with T2D. (2) To conduct a systematic review and meta-summary of published studies describing SGLT2i-associated DKA in T2D.

methodsA retrospective cohort study analysed data from 18 UK hospitals (April 2018-March 2024), using standardised DKA protocols. Propensity score matching compared DKA episodes between SGLT2i users and non-users. In addition, a systematic review and meta-summary was performed including studies from PubMed, EMBASE, MEDLINE, Scopus, and Web of Science focusing on DKA in PwT2D treated with SGLT2i.

resultsWithin the DEKODE cohort, 534 matched individuals were analysed. SGLT2i users had lower glucose, pH, and bicarbonate levels than non-users. 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-users had similar clinical outcomes including duration of DKA and length of hospital stay. In the meta-summary of 1024 cases of SGLT2 inhibitor-associated DKA from 247 studies, the median age was 54.6 years, with 49.7% male and a median diabetes duration of 10 years. Biochemical features included acidosis (median pH 7.1), elevated ketones (5.7 mmol/L), and modest hyperglycaemia (10.6 mmol/L). DKA typically developed after 2 months of SGLT2i use, with 21.1% requiring intensive care admission.

conclusionsDespite 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-users. This may be attributed to earlier identification of euglycaemic DKA, timely intervention, as well as the distinct pathophysiological profile of SGLT2i-associated DKA. Improved education on risk factors and preventive strategies is warranted with SGLT2i therapy.

Indexed as

Diabetes Mellitus, Type 2Diabetic KetoacidosisSodium-Glucose Transporter 2 InhibitorsAdultAgedBlood GlucoseFemaleHospitalizationHumansMaleMiddle AgedRetrospective StudiesTreatment OutcomeUnited KingdomBlood GlucoseSodium-Glucose Transporter 2 Inhibitorsacute complicationsdiabetes ketoacidosissodium‐glucose co‐transporter‐2 inhibitorstype 2 diabetes

Identifiers

PMID40919651
PMCPMC12587257

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.