What question did this study set out to answer?

This study aims to evaluate the risk of diabetic ketoacidosis (DKA) associated with SGLT2 inhibitors compared to DPP4 inhibitors in patients with type 2 diabetes.

March 21, 2026Sage Open Chronic DiseaseOpen Access

Risk of diabetic ketoacidosis with sodium-glucose cotransporter-2 inhibitors compared with dipeptidyl peptidase-4 inhibitors in type 2 diabetes: A nationwide cohort study

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This study aims to evaluate the risk of diabetic ketoacidosis (DKA) associated with SGLT2 inhibitors compared to DPP4 inhibitors in patients with type 2 diabetes.
Conducted a nationwide cohort study using Taiwan’s National Health Insurance Research Database.
Included over 700,000 patients with type 2 diabetes who initiated treatment between 2016 and 2020.
Applied a prevalent new-user design and used inverse probability treatment weighting to balance baseline characteristics.
Identified DKA cases using validated diagnostic codes from hospital admissions and emergency visits.
The incidence of DKA was 0.34 per 1000 person-years in SGLT2 inhibitor users compared to 0.19 per 1000 person-years in DPP4 inhibitor users.
Adjusted hazard ratio for DKA in SGLT2i users was 2.04, indicating a significantly higher risk.
Subgroup analyses showed higher risk among men, older adults, and those with advanced diabetes complications.

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Implication

A nationwide cohort study reports increased diabetic ketoacidosis risk with SGLT2 inhibitors compared to DPP4 inhibitors in type 2 diabetes, suggesting targeted monitoring for high-risk patients.

Cite This Study

Yeh et al. (2026) studied this question.

synapsesocial.com/papers/69be356f6e48c4981c673a94 https://doi.org/10.1177/27558428261421697

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Implication

A nationwide cohort study reports increased diabetic ketoacidosis risk with SGLT2 inhibitors compared to DPP4 inhibitors in type 2 diabetes, suggesting targeted monitoring for high-risk patients.

Risk of diabetic ketoacidosis with sodium-glucose cotransporter-2 inhibitors compared with dipeptidyl peptidase-4 inhibitors in type 2 diabetes: A nationwide cohort study

Key Points

Discussion

Implication

Cite This Study

Risk of diabetic ketoacidosis with sodium-glucose cotransporter-2 inhibitors compared with dipeptidyl peptidase-4 inhibitors in type 2 diabetes: A nationwide cohort study

Key Points

Discussion

Implication

Cite This Study

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