Study IDs Risk Factors for Ketoacidosis in Adults With T2D Receiving SGLT2 Inhibitors

THURSDAY, Sept. 17, 2026 (HealthDay News) — For adults with type 2 diabetes receiving sodium-glucose cotransporter-2 (SGLT2) inhibitors, risk factors for ketoacidosis include high hemoglobin A1c, previous ketoacidosis, and recent hypoglycemia, according to a study published online Sept. 1 in The Lancet Diabetes & Endocrinology.

Erik Kadesjö, M.D., from the Karolinska Institutet in Stockholm, and colleagues examined the incidence, risk factors, and prognosis of ketoacidosis during SGLT2 inhibitor treatment in a cohort of adults with type 2 diabetes from Sweden, Denmark, and Norway. A total of 322,597 treatment episodes were included among 282,282 patients with type 2 diabetes (mean age, 63 years).

The researchers observed 1,452 ketoacidosis events during a median follow-up of 1.3 years (incidence, 2.43 per 1,000 person-years). Risk was highest soon after initiation and persisted through follow-up. High hemoglobin A1c (≥83 versus ≤52 mmol/mol), malnutrition, previous ketoacidosis, low body mass index (<20 versus 20 to <25 kg/m²), and recent hypoglycemia were strong risk factors (odds ratios, 15.37, 10.54, 10.40, 9.98, and 5.22, respectively). The most common precipitating or co-occurring event was infection (31.8 versus 6.1 percent for ketoacidosis cases versus controls; odds ratio, 7.60). The strongest associations were seen for alcohol intoxication, acute renal events, acute abdomen, stroke, and major surgery. In exploratory analyses, observed associations were mainly general to patients with type 2 diabetes and not specific to SGLT2 inhibitor use.

“Our findings are not primarily about avoiding treatment, but about improving our ability to identify high-risk patients and use these medicines more safely,” coauthor Peter Ueda, M.D., also from the Karolinska Institutet, said in a statement.

Several authors disclosed ties to the biopharmaceutical industry.

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